title: Long-term Outcomes After Liver Transplantation Among Human Immunodeficiency Virus-Infected Recipients.
abstract: BACKGROUND
  Early outcomes after human immunodeficiency virus (HIV) + liver transplantation (LT) are encouraging, but data are lacking regarding long-term outcomes and comparisons with matched HIV- patients.
  
  
  METHODS
  We examined outcomes among 180 HIV+ LT, and compared outcomes to matched HIV- counterfactuals (Scientific Registry of Transplant Recipients 2002-2011). Iterative expanding radius matching (1:10) on recipient age, race, body mass index, hepatitis C virus (HCV), model for end-stage liver disease score, and acute rejection; and donor age and race, cold ischemia time, and year of transplant. Patient survival and graft survival were estimated using Kaplan-Meier methodology and compared using log-rank and Cox proportional hazards. Subgroup analyses were performed by transplant era (early: 2002-2007 vs. modern: 2008-2011) and HCV infection status.
  
  
  RESULTS
  Compared to matched HIV- controls, HIV+ LT recipients had a 1.68-fold increased risk for death (adjusted hazard ratio [aHR], 1.68, 95% confidence interval [95% CI], 1.28-2.20; P < 0.001), and a 1.70-fold increased risk for graft loss (aHR, 1.70; 95% CI, 1.31-2.20; P < 0.001). These differences persisted independent of HCV infection status. However, in the modern transplant era risk for death (aHR, 1.11; 95% CI, 0.52-2.35; P = 0.79) and graft loss (aHR, 0.89; 95% CI, 0.42-1.88; P = 0.77) were similar between monoinfected and uninfected LT recipients. In contrast, independent of transplant era, coinfected LT recipients had increased risk for death (aHR, 2.24; 95% CI, 1.43-3.53; P < 0.001) and graft loss (aHR, 2.07; 95% CI, 1.33-3.22; P = 0.001) compared to HCV+ alone LT recipients.
  
  
  CONCLUSIONS
  These results suggest that outcomes among monoinfected HIV+ LT recipients have improved over time. However, outcomes among HIV+ LT recipients coinfected with HCV remain concerning and motivate future survival benefit studies.
authors.affiliation: 1 University of Alabama at Birmingham, Birmingham, AL. 2 Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD. 3 Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, MD.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.forename: Christine
authors.initials: C
authors.lastname: Durand
authors.forename: Rhiannon D
authors.initials: RD
authors.lastname: Reed
authors.forename: Paul A
authors.initials: PA
authors.lastname: MacLennan
authors.forename: Shikha
authors.initials: S
authors.lastname: Mehta
authors.forename: Allan
authors.initials: A
authors.lastname: Massie
authors.forename: Anoma
authors.initials: A
authors.lastname: Nellore
authors.forename: Derek
authors.initials: D
authors.lastname: DuBay
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D060085:Coinfection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D005260:Female; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D020276:HIV Long-Term Survivors; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States