title: Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients.
abstract: BACKGROUND
  In this report, we examine the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplantation (TX) recipients in a prospective nonrandomized U.S. multicenter trial.
  
  
  METHODS
  Subjects were required to have CD4+ T-cell counts >200/100 cells/mm3 (K/L) and undetectable plasma HIV-1 RNA (Viral Load [VL]) (K) or expected posttransplantation suppression (L). Impact of SCs (N ≥ 7) was evaluated by use of the proportional hazards models. Baseline morbidity predictors for SCs (N ≥ 7) were assessed in univariate proportional hazards models.
  
  
  RESULTS
  At median 2.7 (interquartile range 1.9-4.1) and 2.3 (1.0-3.7) years after TX, 3-month and 1-year graft survival were [K] 96% (95% CI 91%-98%) and 91% (95% CI 85%-94%) and [L] 91% (95% CI 85%-95%) and 77% (95% CI 69%-84%), respectively. A total of 14 K and 28 L graft losses occurred in the first year; 6 K and 11 L were in the first 3 months. A total of 26 (17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (hazard ratio [HR] 2.8; 95% CI 1.0-8.4; P = .06) with increased risk of graft loss, whereas a greater MELD score before transplantation (HR 1.07 per point increase; 95% CI: 1.01-1.14; P = .02), and detectable viral load before TX (HR 3.6; 95% CI 0.9-14.6; P = .07) was associated with an increased risk of wound infections/dehiscence.
  
  
  CONCLUSIONS
  The rates and outcomes of surgical complications are similar to what has been observed in the non-HIV setting in carefully selected HIV-infected liver and kidney TX recipients.
authors.affiliation: University of California, San Francisco, San Francisco, CA 94143-0470, USA. jack.harbell@ucsfmedctr.org
authors.forename: Jack
authors.initials: J
authors.lastname: Harbell
authors.forename: John
authors.initials: J
authors.lastname: Fung
authors.forename: Nicholas
authors.initials: N
authors.lastname: Nissen
authors.forename: Kim
authors.initials: K
authors.lastname: Olthoff
authors.forename: Sander S
authors.initials: SS
authors.lastname: Florman
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Jimmy
authors.initials: J
authors.lastname: Light
authors.forename: Steve T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Pearson
authors.forename: Burc
authors.initials: B
authors.lastname: Barin
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Roland
authors.forename: Peter G
authors.initials: PG
authors.lastname: Stock
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology; D006085:Graft Survival; D015658:HIV Infections / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D015996:Survival Rate; D014180:Transplantation / Q000706:statistics & numerical data; D019562:Viral Load