Intention-to-treat survival analysis of hepatitis C virus/human immunodeficiency virus coinfected liver transplant: Is it the waiting list?
In human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the accelerated severity of liver disease, associated comorbidities, and mortality on the waiting list could change the possibility and results of liver transplantation (LT). Intention-to-treat survival analysis (ITTA) can accurately estimate the applicability and efficacy of LT. The primary objective of this study was to compare the survival of patients with HCV with and without HIV infection. We analyzed a cohort of 199 patients with HCV infection enrolled for LT between 1998 and 2015; 17 were also infected with HIV. The patients with HCV/HIV coinfection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%; P < 0.001). ITTA at 1, 3, and 4 years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV coinfection, respectively (Wilcoxon test P < 0.05). The ITTA at 1, 3, 6, and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV coinfection, respectively (log-rank P < 0.05; Wilcoxon test P < 0.01). A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age > 70 years (hazard ratio [HR] = 3.12; P < 0.05), United Network for Organ Sharing status 1 (HR = 10.1; P < 0.01), Model for End-Stage Liver Disease (HR = 1.13; P < 0.001), and HIV coinfection (HR = 2.65; P < 0.05) had independent negative predictive value for survival. In conclusion, our study indicates that HIV coinfection is a factor in mortality prior to transplantation and associated with higher mortality on the waiting list. Liver Transplantation 22 1186-1196 2016 AASLD.
Transplant Procurement Management, University Hospital Lozano Blesa, Zaragoza, Spain.|Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.|Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain.
Juan J
JJ
Araiz
Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain.|Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
M Trinidad
MT
Serrano
Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.|Hepatic Surgery Unit, Department of Surgery, University Hospital Lozano Blesa, Zaragoza, Spain.|Department of Surgery, University of Zaragoza, Zaragoza, Spain.
Francisco A
FA
García-Gil
Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.
Elena M
EM
Lacruz
Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
Sara
S
Lorente
Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.
José I
JI
Sánchez
Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.|Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain.
Miguel A
MA
Suarez
D000328:Adult; D000367:Age Factors; D060085:Coinfection / Q000401:mortality* / Q000821:virology; D058625:End Stage Liver Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D019737:Transplants / Q000821:virology; D014850:Waiting Lists / Q000401:mortality*