Human immunodeficiency virus–infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study

Abstract

There is a lack of data on incidental hepatocellular carcinoma (iHCC) in the setting of liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients. This study aims to describe the frequency, histopathological characteristics, and outcomes of HIV+ LT recipients with iHCC from a Spanish multicenter cohort in comparison with a matched cohort of LT patients without HIV infection. A total of 15 (6%) out of 271 patients with HIV infection who received LT in Spain from 2002 to 2012 and 38 (5%) out of the 811 HIV- counterparts presented iHCC in liver explants (P = 0.58). Patients with iHCC constitute the present study population. All patients also had hepatitis C virus (HCV)-related cirrhosis. There were no significant differences in histopathological features of iHCC between the 2 groups. Most patients showed a small number and size of tumoral nodules, and few patients had satellite nodules, microvascular invasion, or poorly differentiated tumors. After a median follow-up of 49 months, no patient developed hepatocellular carcinoma (HCC) recurrence after LT. HIV+ LT recipients tended to have lower survival than their HIV- counterparts at 1 (73% versus 92%), 3 (67% versus 84%), and 5 years (50% versus 80%; P = 0.06). There was also a trend to a higher frequency of HCV recurrence as a cause of death in the former (33% versus 10%; P = 0.097). In conclusion, among LT recipients for HCV-related cirrhosis, the incidence and histopathological features of iHCC in HIV+ and HIV- patients were similar. However, post-LT survival was lower in HIV+ patients probably because of a more aggressive HCV recurrence. Liver Transplantation 23 645-651 2017 AASLD.

Clinical outcomes of liver transplantation in human immunodeficiency virus/hepatitis B virus coinfected patients in China

“…HCV recurrence in HIV patients is more aggressive, and liver fibrosis is more rapid due to HAART toxicity [ 25 ]. An increasing body of evidence suggests that treatment for HCV recurrence positively affects graft survival and mortality [ 26 , 27 ]. Unlike HCV coinfection, HIV-infected patients with HBV appear to have better outcomes after OLT when HBV reinfection prophylaxis is properly provided [ 28 ].…”

AIDS Clinical Research in Spain—Large HIV Population, Geniality of Doctors, and Missing Opportunities

“…Interestingly, survival is not worsened by HIV in liver transplant recipients with hepatocellular carcinoma, being above 65% at five years [ 87 ]. Moreover, incident liver cancer in allografts is not more frequent in the HIV setting [ 88 ]. Outcomes in this population are rapidly improving following the advent of new direct acting antivirals for hepatitis C [ 89 ].…”

Effect of HIV infection on pre‐ and post‐liver transplant mortality in patients with organ failure

“…As end‐stage liver disease is the main cause of death among patients coinfected with HBV or HCV or with nonviral hepatitis, liver transplantation (LT) became the most feasible way to treat these patients after HAART was implemented in clinical practice [6]. However, cohort studies from the USA [7], Germany [8] and Spain [9,10] showed a post‐LT 5‐year survival rate of only 50–55% in HIV/HCV‐coinfected liver recipients. Post‐LT long‐term survival in HIV/HCV‐coinfected recipients was poorer than in HCV‐monoinfected recipients [11].…”