title: Liver Retransplantation in Patients With HIV-1 Infection: An International Multicenter Cohort Study.
abstract: Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents.
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Agüero
authors.affiliation: Liver Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain, and CIBEREHD, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rimola
authors.affiliation: Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: P
authors.initials: P
authors.lastname: Stock
authors.affiliation: Infectious Diseases Section, Department of Surgical and Morphological Sciences, University of Insubria, Varese and National Center for Transplantation, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Grossi
authors.affiliation: Department of Medicine, University of Bonn, Bonn, Germany.
authors.forename: J K
authors.initials: JK
authors.lastname: Rockstroh
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Agarwal
authors.affiliation: Institute for Infectious Diseases, Bern University Hospital, Berne, Switzerland and Department of Infectious Diseases, Inselspital, Bern and University Hospital and University of Bern, Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Garzoni
authors.affiliation: Infectious Disease Section, Internal Medicine, Hospital Italiano, Buenos Aires, Argentina.
authors.forename: L A
authors.initials: LA
authors.lastname: Barcan
authors.affiliation: Department of Infectious Diseases, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Maltez
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Manzardo
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Mari
authors.affiliation: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: M V
authors.initials: MV
authors.lastname: Ragni
authors.affiliation: Department of Medicine, University of Bonn, Bonn, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Anadol
authors.affiliation: HPB Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Di Benedetto
authors.affiliation: Miami Transplant Institute, Department of Surgery, University of Miami, Miami, FL.
authors.forename: S
authors.initials: S
authors.lastname: Nishida
authors.affiliation: Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Bilbao, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Gastaca
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miró
mesh_terms: D000328:Adult; D015331:Cohort Studies; D060085:Coinfection / Q000150:complications / Q000601:surgery* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D015658:HIV Infections / Q000150:complications / Q000601:surgery* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications / Q000601:surgery* / Q000821:virology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications / Q000601:surgery* / Q000821:virology; D006801:Humans; D007390:International Agencies; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate