Advertisement

Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection§

Authors


  • Burc Barin and Donald M. Stablein have full access to all data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis. Norah A. Terrault, Michelle E. Roland, Margaret V. Ragni, John Fung, Donald M. Stablein, Lawrence Fox, Jonah Odim, and Peter G. Stock contributed to the study concept and design. Norah A. Terrault, Michelle E. Roland, Thomas Schiano, Lorna Dove, Michael T. Wong, Fred Poordad, Margaret V. Ragni, David Simon, Kim M. Olthoff, Lynt Johnson, Valentina Stosor, Dushyantha Jayaweera, John Fung, Kenneth E. Sherman, Aruna Subramanian, J. Michael Millis, Douglas Slakey, Carl L. Berg, Laurie Carlson, Linda Ferrell, and Peter G. Stock contributed to the acquisition of data. Norah A. Terrault, Michelle E. Roland, Thomas Schiano, Lorna Dove, Michael T. Wong, Fred Poordad, Margaret V. Ragni, Burc Barin, David Simon, Kim M. Olthoff, Lynt Johnson, Valentina Stosor, Dushyantha Jayaweera, John Fung, Kenneth E. Sherman, Aruna Subramanian, J. Michael Millis, Douglas Slakey, Carl L. Berg, Laurie Carlson, Linda Ferrell, Donald M. Stablein, Lawrence Fox, Jonah Odim, and Peter G. Stock contributed to the interpretation of data. Norah A. Terrault, Michelle E. Roland, Burc Barin, Donald M. Stablein, and Peter G. Stock contributed to the drafting of the manuscript. Norah A. Terrault, Michelle E. Roland, Thomas Schiano, Lorna Dove, Michael T. Wong, Fred Poordad, Margaret V. Ragni, Burc Barin, David Simon, Kim M. Olthoff, Lynt Johnson, Valentina Stosor, Dushyantha Jayaweera, John Fung, Kenneth E. Sherman, Aruna Subramanian, J. Michael Millis, Douglas Slakey, Carl L. Berg, Laurie Carlson, Linda Ferrell, Donald M. Stablein, Lawrence Fox, Jonah Odim, and Peter G. Stock contributed to the critical revision of the manuscript for important intellectual content. Norah A. Terrault, Michelle E. Roland, Burc Barin, Donald M. Stablein, and Peter G. Stock contributed to the statistical analysis. Michelle E. Roland and Peter G. Stock obtained funding. Norah A. Terrault, Michelle E. Roland, Laurie Carlson, Jonah Odim, Lawrence Fox, and Peter G. Stock contributed to the supervision of the study.

  • All the authors completed and submitted copyright assignment, authorship responsibility, National Institutes of Health funding, financial disclosure, institutional review board/animal care committee approval, and sponsorship forms, and no conflicts were reported.

  • §

    The Committee on Human Research at the University of California San Francisco approved the study protocol, as did the institutional review board of each participating center. Each participant provided written informed consent.

  • Potential Conflicts of Interest: Dr. Schiano consults for Vertex, Merck, Salix, and Gilead. Dr. Poordad advises and received grants from Abbott, Anadys, Achillion, and Tibotec. He advises, is on the speakers' bureau for, and received grants from Gilead, Genentech, Merck, and Vertex. He is also on the speakers' bureau for Salix and Onyx and received grants from Bristol Meyers Squibb, Pharmasset, and Boehringer Ingleheim. Dr. Jayaweera consults, advises, and is on the speakers' bureau for Gillead and consults, advises, and received grants from Viiv. He consults, advises, is on the speakers' bureau for, and received grants from Bristol Meyers Squibb and Tibotec. He also received grants from Vertex. Dr. Sherman advises Bristol Meyers Squibb, Glaxo Smith Kline, Baxter, Regulus, and Fibrogen, and received grants from Roche, Gilead, Siemens, Anadys, and Pharmasset. He advises and received grants from Merck, Vertex, Boehringer Ingleheim, and SciClone

Abstract

Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in human immunodeficiency virus (HIV)–infected patients because of reportedly poor outcomes. This prospective, multicenter US cohort study compared patient and graft survival for 89 HCV/HIV-coinfected patients and 2 control groups: 235 HCV-monoinfected LT controls and all US transplant recipients who were 65 years old or older. The 3-year patient and graft survival rates were 60% [95% confidence interval (CI) = 47%-71%] and 53% (95% CI = 40%-64%) for the HCV/HIV patients and 79% (95% CI = 72%-84%) and 74% (95% CI = 66%-79%) for the HCV-infected recipients (P < 0.001 for both), and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among the HCV/HIV patients, older donor age [hazard ratio (HR) = 1.3 per decade], combined kidney-liver transplantation (HR = 3.8), an anti-HCV–positive donor (HR = 2.5), and a body mass index < 21 kg/m2 (HR = 3.2) were independent predictors of graft loss. For the patients without the last 3 factors, the patient and graft survival rates were similar to those for US LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher for the HCV/HIV patients versus the HCV patients (39% versus 24%, log rank P = 0.02), but the cumulative rates of severe HCV disease at 3 years were not significantly different (29% versus 23%, P = 0.21). In conclusion, patient and graft survival rates are lower for HCV/HIV-coinfected LT patients versus HCV-monoinfected LT patients. Importantly, the rates of treated acute rejection (but not the rates of HCV disease severity) are significantly higher for HCV/HIV-coinfected recipients versus HCV-infected recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients, but recipient and donor selection and the management of acute rejection strongly influence outcomes. Liver Transpl 18:716–726, 2012. © 2012 AASLD.

Ancillary