Clinical characteristics of human immunodeficiency virus patients being referred for liver transplant evaluation: a descriptive cohort study.
BACKGROUND
Liver transplantation (LT) is a treatment option for select human immunodeficiency virus (HIV)-infected patients with advanced liver disease. The aim of this study was to describe LT evaluation outcomes in HIV-infected patients.


METHODS
All HIV-infected patients referred for their first LT evaluation at the Mount Sinai Medical Center were included in this retrospective, descriptive cohort study. Multivariable logistic regression was used to identify factors independently associated with listing.


RESULTS
Between February 2000 and April 2012, 366 patients were evaluated for LT, with 66 (18.0%) listed for LT and 300 (82.0%) not listed. Fifty-one patients (13.9%) died before completing evaluation and 85 (23.2%) were too early for listing. Reasons patients were declined for listing were psychosocial (15.8%), HIV-related (10.4%), loss to follow-up (9.6%), surgical/medical (6.0%), liver-related (4.4%), patient choice (3.4%), and financial (1.6%). Listed patients were more likely to have hepatocellular carcinoma (HCC) (43.1% vs. 17.1%; P < 0.0001) and less likely to have hepatitis B (6.2% vs. 15.7%; P = 0.04) or a psychiatric history (19.7% vs. 35.2%; P = 0.02) than those not listed. In multivariable analysis, HCC (odds ratio [OR] 5.79; 95% confidence interval [95% CI]: 2.97-11.28), model for end-stage liver disease (MELD) score at referral (OR 1.06; 95% CI 1.01-1.11), and hepatitis B (OR 0.26; 95% CI 0.08-0.79) were associated with listing.


CONCLUSIONS
MELD score and HCC were positive predictors of listing in HIV-infected patients referred for LT evaluation and, therefore, timely referrals are vital in these patients. As MELD is a predictor for death while undergoing evaluation, rapid evaluation should be performed in HIV-infected patients with a higher MELD score.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.|Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
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Martel-Laferrière
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Michel
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Schaefer
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Bindal
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Bichoupan
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Branch
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Huprikar
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Schiano
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Perumalswami
D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014850:Waiting Lists / Q000401:mortality
HIV; MELD score; hepatitis B; hepatitis C; hepatocellular carcinoma; liver transplant evaluation; waiting list