Pretransplant survival is shorter in HIV-positive than HIV-negative subjects with end-stage liver disease

Authors

  • Margaret V. Ragni,

    Corresponding author
    1. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
    3. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    4. Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
    • Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Director, Hemophilia Center of Western Pennsylvania, 3636 Boulevard of the Allies, Pittsburgh, PA 15213-4306

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    • Telephone: 412-209-7288; FAX: 412-209-7281

  • Bijan Eghtesad,

    1. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    Current affiliation:
    1. Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH
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  • Kimberly W. Schlesinger,

    1. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
    3. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    4. Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
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  • Igor Dvorchik,

    1. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Department of Biostatistics, Graduate School of Public Health, Pittsburgh, PA
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  • John J. Fung

    1. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
    Current affiliation:
    1. Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH
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Abstract

Despite improved survival after liver transplantation (OLTX) in HIV-positive individuals treated with highly active antiretroviral therapy (HAART), some transplant candidates do not survive to OLTX. To determine if pretransplant outcome is related to severity of liver disease and/or HIV infection, we prospectively evaluated 58 consecutive HIV-positive candidates seen at a single center from 1997-2002. Of the 58, 15 (25.9%) were transplanted, whereas 21 (36.2%) died before OLTX, a median one month of evaluation, with more than half of those (12 of 21, 57.1%) dying from infection. By contrast, of 1,359 HIV-negative candidates, 860 (63.3%) were transplanted, whereas 211 (15.5%) died before OLTX (P < 0.001). The cumulative survival following initial evaluation was significantly shorter among HIV-positive than HIV-negative candidates (880 vs. 1,427 days, P = 0.035, Breslow) but was not related to the initial pretransplant MELD score (16 vs. 15), INR (1.5 vs. 1.5), creatinine (1.3 vs. 1.3 mg/dL), or total bilirubin (6.6 vs. 5.7 mg/dL), respectively, all P > 0.05. Among untransplanted HIV-positive candidates, the 21 who died did not differ from the 22 surviving in initial MELD (15 vs. 13), CD4 (230 vs. 327/μL), HIV load (both < 400 copies/mL), HAART intolerance (10/21, 47.6% vs. 10/22, 45.4%), or HCV infection (16/21, 76.2% vs. 16/22, 72.3%), all P > 0.05. Further, the 21 did not differ from the 15 transplanted in pre-OLTX CD4, HIV load, or MELD score, all P > 0.05. In conclusion, pretransplant survival appears shorter in HIV-positive OLTX candidates and is unrelated to severity of liver or HIV disease. Further study is warranted to determine risk factors for poorer pretransplant outcomes. (Liver Transpl 2005;11:1425–1430)

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