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

✍ Scribed by Margaret V. Ragni; Bijan Eghtesad; Kimberly W. Schlesinger; Igor Dvorchik; John J. Fung

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 105 KB
• Volume: 11
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20534

✦ Synopsis

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/ L), 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.)

A lthough progression to end-stage liver disease (ESLD) occurs more rapidly in those with HIV infection than in those who are HIV negative, 1 survival after liver transplantation (OLTX) in HIV-positive individuals with ESLD has improved, 2 likely related to the improved control of HIV replication possible with highly active antiretroviral therapy (HAART). 3 -5 Despite these improved outcomes after transplantation, however, some HIV-positive candidates do not survive long enough to be transplanted, despite an allocation system independent of HIV status. 6 We hypothesized that poorer pretransplant survival is related to the severity of pretransplant liver disease and/or HIV disease. To test this hypothesis, pretransplant outcomes were prospectively studied in HIV-positive candidates initially evaluated at the Thomas Starzl Transplantation Institute between 1997 and 2002 and compared with HIV-negative transplant candidates evaluated during the same period.