title: Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls.
abstract: OBJECTIVE
  To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients.
  
  
  METHODS
  Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls.
  
  
  METHODS
  We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models.
  
  
  RESULTS
  There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P < 0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P = 0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P = 0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P = 0.07) and HR 1.4 (P = 0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis.
  
  
  CONCLUSIONS
  Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest.
  
  
  BACKGROUND
  ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.
authors.affiliation: aDepartment of Medicine, University of California, San Francisco, San Francisco, CaliforniabEMMES Corporation, Rockville, MarylandcIcahn School of Medicine at Mount Sinai, New York, New YorkdBeth Israel Deaconess Medical Center, Boston, MassachusettseUniversity of Pennsylvania, Philadelphia, PennsylvaniafRush University Medical Center, Chicago, IllinoisgDavid Geffen School of Medicine, UCLA and Cedars Sinai Medical Center, Los AngeleshDepartment of Surgery, University of California, San Francisco, San Francisco, California, USA.*Douglas W. Hanto's current affiliation is Vanderbilt University, Nashville, TN, USA.†George Beatty current affiliation is California Department of Corrections and Rehabilitation, California, USA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Roland
authors.forename: Burc
authors.initials: B
authors.lastname: Barin
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Barbara
authors.initials: B
authors.lastname: Murphy
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Emily
authors.initials: E
authors.lastname: Blumberg
authors.forename: Kim
authors.initials: K
authors.lastname: Olthoff
authors.forename: David
authors.initials: D
authors.lastname: Simon
authors.forename: William D
authors.initials: WD
authors.lastname: Hardy
authors.forename: George
authors.initials: G
authors.lastname: Beatty
authors.forename: Peter G
authors.initials: PG
authors.lastname: Stock
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D066027:Transplant Recipients; D017211:Treatment Failure