TY - JOUR
T1 - Long-Term outcomes after liver transplantation among human immunodeficiency virus-infected recipients
AU - Locke, Jayme E.
AU - Durand, Christine
AU - Reed, Rhiannon D.
AU - MacLennan, Paul A.
AU - Mehta, Shikha
AU - Massie, Allan
AU - Nellore, Anoma
AU - DuBay, Derek
AU - Segev, Dorry L.
N1 - Funding Information:
This research was supported in part by NIH K24DK101828 (PI: Segev).
Publisher Copyright:
© Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Background. Early outcomes after human immunodeficiency virus (HIV) + liver transplantation (LT) are encouraging, but data are lacking regarding long-Term outcomes and comparisons with matched HIV? patients. Methods. We examined outcomes among 180 HIV+ LT, and compared outcomes to matched HIV? counterfactuals (Scientific Registry of Transplant Recipients 2002-2011). Iterative expanding radius matching (1:10) on recipient age, race, body mass index, hepatitis C virus (HCV), model for end-stage liver disease score, and acute rejection; and donor age and race, cold ischemia time, and year of transplant. Patient survival and graft survival were estimated using Kaplan-Meier methodology and compared using log-rank and Cox proportional hazards. Subgroup analyses were performed by transplant era (early: 2002-2007 vs modern: 2008-2011) and HCV infection status. Results. Compared to matched HIV? controls, HIV+ LT recipients had a 1.68-fold increased risk for death (adjusted hazard ratio [aHR], 1.68, 95% confidence interval [95% CI], 1.28-2.20; P<0.001), and a 1.70-fold increased risk for graft loss (aHR, 1.70; 95% CI, 1.31-2.20; P<0.001). These differences persisted independent of HCV infection status. However, in themodern transplant era risk for death (aHR, 1.11; 95% CI, 0.52-2.35; P = 0.79) and graft loss (aHR, 0.89; 95% CI, 0.42-1.88; P = 0.77) were similar between monoinfected and uninfected LT recipients. In contrast, independent of transplant era, coinfected LT recipients had increased risk for death (aHR, 2.24; 95% CI, 1.43-3.53; P<0.001) and graft loss (aHR, 2.07; 95% CI, 1.33-3.22; P = 0.001) compared to HCV+ alone LTrecipients.Conclusions. These results suggest that outcomes amongmonoinfected HIV+ LTrecipients have improved over time. However, outcomes among HIV+ LT recipients coinfected with HCV remain concerning and motivate future survival benefit studies.
AB - Background. Early outcomes after human immunodeficiency virus (HIV) + liver transplantation (LT) are encouraging, but data are lacking regarding long-Term outcomes and comparisons with matched HIV? patients. Methods. We examined outcomes among 180 HIV+ LT, and compared outcomes to matched HIV? counterfactuals (Scientific Registry of Transplant Recipients 2002-2011). Iterative expanding radius matching (1:10) on recipient age, race, body mass index, hepatitis C virus (HCV), model for end-stage liver disease score, and acute rejection; and donor age and race, cold ischemia time, and year of transplant. Patient survival and graft survival were estimated using Kaplan-Meier methodology and compared using log-rank and Cox proportional hazards. Subgroup analyses were performed by transplant era (early: 2002-2007 vs modern: 2008-2011) and HCV infection status. Results. Compared to matched HIV? controls, HIV+ LT recipients had a 1.68-fold increased risk for death (adjusted hazard ratio [aHR], 1.68, 95% confidence interval [95% CI], 1.28-2.20; P<0.001), and a 1.70-fold increased risk for graft loss (aHR, 1.70; 95% CI, 1.31-2.20; P<0.001). These differences persisted independent of HCV infection status. However, in themodern transplant era risk for death (aHR, 1.11; 95% CI, 0.52-2.35; P = 0.79) and graft loss (aHR, 0.89; 95% CI, 0.42-1.88; P = 0.77) were similar between monoinfected and uninfected LT recipients. In contrast, independent of transplant era, coinfected LT recipients had increased risk for death (aHR, 2.24; 95% CI, 1.43-3.53; P<0.001) and graft loss (aHR, 2.07; 95% CI, 1.33-3.22; P = 0.001) compared to HCV+ alone LTrecipients.Conclusions. These results suggest that outcomes amongmonoinfected HIV+ LTrecipients have improved over time. However, outcomes among HIV+ LT recipients coinfected with HCV remain concerning and motivate future survival benefit studies.
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U2 - 10.1097/TP.0000000000000829
DO - 10.1097/TP.0000000000000829
M3 - Article
C2 - 26177090
AN - SCOPUS:84952334357
SN - 0041-1337
VL - 100
SP - 141
EP - 146
JO - Transplantation
JF - Transplantation
IS - 1
ER -