title: Beyond the NIH Multicenter HIV Transplant Trial Experience: Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Coinfected Recipients in the United States.
abstract: BACKGROUND
  The effectiveness of liver transplant (LT) in human immunodeficiency virus (HIV) and HIV/hepatitis C virus (HCV) coinfected recipients in the United States is unknown. We investigated (i) the effect of HIV on US patient and allograft LT outcomes, compared to HCV+ and HIV/HCV uninfected recipients and (ii) whether LT at centers that participated in the National Institutes of Health (NIH) Solid Organ Transplantation in HIV Trial, reflecting experience and a standardized approach to patient selection, impacted outcomes.
  
  
  METHODS
  A retrospective cohort study of primary LT recipients transplanted 27 February 2002 through 31 December 2013, categorized by serostatus: HCV+ (n = 20 829), HIV+ (n = 72), HIV+/HCV+ (n = 160), and HIV-/HCV- uninfected (n = 22 926) as reference. Survival was determined using Cox regression, stratified according to center NIH trial participation.
  
  
  RESULTS
  HCV (hazard ratio [HR] 1.46, 95% confidence interval [CI], 1.41-1.52) and HIV/HCV coinfection (HR 2.62, 95% CI, 2.06-3.33) were associated with mortality; HIV monoinfection was not (HR 1.37, 95% CI, .86-2.18). This was unchanged after stratification on NIH trial participation, although mortality was higher in NIH-enrolling (HIV+: HR 1.65, 95% CI, .93-2.92; HIV+/HCV+: HR 3.15, 95% CI, 2.32-4.28) than in non-enrolling centers (HIV+: HR 1.03, 95% CI, .43-2.47, HIV+/HCV+: HR 2.55, 95% CI, 1.64-3.96). Although allograft loss was higher in HIV/HCV coinfected recipients transplanted at enrolling (HR 2.64, 9%% CI, 1.91-3.64) vs nonenrolling centers (HR 2.22, 95% CI, 1.41-3.49), there was no difference in HIV and HCV monoinfected patients.
  
  
  CONCLUSIONS
  HIV+ LT recipient outcomes were superior to HCV+ or HIV/HCV coinfected recipients. Despite a standardized approach and plausibly more experience with HIV patients, transplantation at NIH study center did not improve outcomes.
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Sawinski
authors.affiliation: Department of Medicine, Division of Gastroenterology Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine.
authors.forename: David S
authors.initials: DS
authors.lastname: Goldberg
authors.affiliation: Department of Medicine, Division of Infectious Disease.
authors.forename: Emily
authors.initials: E
authors.lastname: Blumberg
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Abt
authors.affiliation: Department of Medicine, Renal Electrolyte and Hypertension Division.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.affiliation: Department of Medicine, Division of Gastroenterology Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
mesh_terms: D000328:Adult; D060085:Coinfection / Q000150:complications* / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: hepatitis C virus (HCV); human immunodeficiency virus (HIV); liver transplant; outcomes