title: Infectious complications after liver transplantation in human immunodeficiency virus-infected recipients.
abstract: BACKGROUND
  Few studies have investigated infections in human immunodeficiency virus (HIV)-infected liver transplant patients. The aim of this study was to describe the prevalence, time of onset, mortality of infectious complications, other than hepatitis C virus (HCV), and to identify risk factors for their development in a large single-center cohort of HIV-infected liver transplant patients.
  
  
  METHODS
  We studied 109 consecutive HIV-infected patients who underwent liver transplantation (LT) between 1999 and 2010 and followed until December 2012.
  
  
  RESULTS
  The median age was 44 years (interquartile range [IQR] 41-49), 82.6% were male, and the median follow-up was 45.7 months (IQR 14-65). The major indications for LT were HCV cirrhosis (61%) and hepatocellular carcinoma (19%). Forty patients (37%) developed at least 1 infection during the first year after LT. Twenty-eight (26%) patients had an episode of bacteremia. Five (4.6%) patients developed a cytomegalovirus infection. Fungal infections occurred in 5 (4.5%) patients. Four (3.6%) patients developed an HIV-related opportunistic infection. A total of 43 (39.4%) patients died during follow-up. Mortality related to infection occurred in 9 (7%) cases, and 20 (42.5%) patients died because of HCV recurrence. No patients died from opportunistic infections. Model for end-stage liver disease (MELD) score >17 was associated with a 2-fold higher risk (hazard ratio 1.96; 95% confidence interval 1.01-3.80) of developing infectious complications.
  
  
  CONCLUSIONS
  Infections are not a major cause of mortality after LT in HIV patients and opportunistic infections of acquired immunodeficiency syndrome are infrequent. A MELD score >17 increased the risk of developing post-LT infectious complications. Recurrence of HCV infection remains a major cause of mortality.
authors.affiliation: Service de Médecine Interne Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.|Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Teicher
authors.affiliation: Centre for research in Epidemiology and Population Health - U1018, Inserm, Le Kremlin-Bicêtre, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: F
authors.initials: F
authors.lastname: Boufassa
authors.affiliation: Service de Médecine Interne Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: D
authors.initials: D
authors.lastname: Vittecoq
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.
authors.forename: T M
authors.initials: TM
authors.lastname: Antonini
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.
authors.forename: M-G
authors.initials: MG
authors.lastname: Tateo
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Coilly
authors.affiliation: Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.|Département de Microbiologie et Virologie, AP-HP Hôpital Paul-Brousse, Villejuif, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Roque-Afonso
authors.affiliation: Département de Microbiologie et Virologie, AP-HP Hôpital Paul-Brousse, Villejuif, France.
authors.forename: N
authors.initials: N
authors.lastname: Kassis-Chikhani
authors.affiliation: Univ Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: O
authors.initials: O
authors.lastname: Lambotte
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.
authors.forename: P
authors.initials: P
authors.lastname: Ichai
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.|DHU Hepatinov, Villejuif, France.|Univ Paris-Sud, Le Kremlin-Bicêtre, France.|Unité 1193, Inserm, Villejuif, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Duclos-Vallee
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis
keywords: HIV; bacterial infection; fungal infection; liver transplantation; opportunistic infection; viral infection