Long-Term Outcomes of Orthotopic Liver Transplantation in Human Immunodeficiency Virus–Infected Patients and Comparison With Human Immunodeficiency Virus–Negative Cases

Baccarani, Umberto; Adani, Gian Luigi; Bragantini, F.; Londero, Ambrogio P.; Comuzzi, C.; Rossetto, Anna; Lorenzin, Dario; Bresàdola, Vittorio; Risaliti, Andrea; Pea, Federico; Toniutto, Pierluigi; Donini, Annibale; Anna, D. De; Bresadola, F; Tavio, Marcello; Viale, Pierluigi

doi:10.1016/j.transproceed.2011.01.124

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…Similarly low rates have been reported in other centers [25–30]. The lack of association of history of pre-transplant opportunistic infection and nadir CD4 + cell count with mortality indicates that current immune status and degree of viral control is a more important consideration than HIV clinical history in pre-transplant evaluation.…”

Section: Discussionsupporting

confidence: 52%

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls

Roland¹,

Barin²,

Huprikar³

et al. 2015

AIDS

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Objectives To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients. Design Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls. Methods We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models. Results There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P <0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P =0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P =0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P =0.07) and HR 1.4 (P =0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis. Conclusion Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest. Trial Registration ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.

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Section: Discussionsupporting

confidence: 52%

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls

Roland¹,

Barin²,

Huprikar³

et al. 2015

AIDS

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“…Kidney transplant outcomes in the HAART era are similar between HIV‐positive and negative patients with the 3‐year patient and graft survival of 90% 4,5 . Similar outcomes have been reported in liver transplantation with equivalent 1‐, 3‐, and 5‐year patient and graft survival rates between HIV‐positive and negative liver transplant recipients 6 …”

Section: Introductionsupporting

confidence: 65%

“…4,5 Similar outcomes have been reported in liver transplantation with equivalent 1-, 3-, and 5-year patient and graft survival rates between HIV-positive and negative liver transplant recipients. 6 Orthotopic heart transplantation (OHT) is rarely performed in HIVpositive patients despite the fact that HIV-associated cardiomyopathy is a major long-term complication of HIV infection. The prevalence of heart failure in HIV-positive patients is twofold higher than in HIV-negative Nicolas A. Brozzi and Jacques Simkins contributed equally to this study.…”

Section: Introductionmentioning

confidence: 99%

Advanced heart failure therapies in patients with stable HIV infection

et al. 2020

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Background Human immunodeficiency virus (HIV) infection affects nearly 38 million people worldwide. Patients living with HIV (PLHIV) on modern highly active antiretroviral therapy face significant morbidity and mortality related to the progression of chronic diseases, which lead to an increase in the burden of end‐stage organ disease and organ failure. PLHIV present a two fold increased risk of heart failure as compared with the general population, with a prevalence of clinical heart failure of 6.5 %. Orthotopic heart transplantation (OHT) is rarely performed in HIV‐positive patients despite the fact that HIV‐associated cardiomyopathy is a major long‐term complication of HIV infection. Material and Methods We present a case of PLHIV presenting with decompensated heart failure, requiring initial therapy with left ventricular assist device, followed by heart transplantation, accompanied by an update on current concepts, and experience in the field. Discussion and Conclusion HIV‐associated cardiomyopathy is a major long‐term complication of HIV infection. LVAD support or OHT should also be encouraged among HIV‐positive patients as current data indicates that AHFT is safe in carefully selected HIV‐positive patients and outcomes are similar to those of HIV‐negative patients.

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“…At that time, the outcomes of LT were very poor . Recent series of reports are listed in Table . The reality is that, in addition to those listed therein, there have been many sporadic reports, such as reviews, expectations for liver transplantation, and assessment of indications.…”

Section: Current Results Of Lt For Hiv/hcv Co‐infected Patients In 2013mentioning

confidence: 99%

Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus co‐infection: update in 2013

Eguchi

Takatsuki

Kuroki

2013

J Hepato Biliary Pancreat

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Because of the progress of anti-retroviral therapy (ART) for human immunodeficiency virus (HIV), mortality due to opportunistic infection resulting in AIDS has been remarkably reduced. However, meanwhile, half of those patients have died of end-stage liver cirrhosis due to hepatitis C virus (HCV) with liver cirrhosis and early occurrence of hepatocellular carcinoma. Recently, in 2013, noncirrhotic portal hypertension due to ART drugs or still unknown mechanisms have become problematic with early progression of the disease in this patient population. Liver transplantation (LT) could be one treatment of choice in such cases, but the indications for LT perioperative management, including both HIV and HCV treatments and immunosuppression, are still challenging. In this review, we update the literature on HIV/HCV co-infection and LT as well as recent effort for modifying allocation system for those patients.

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Long-Term Outcomes of Orthotopic Liver Transplantation in Human Immunodeficiency Virus–Infected Patients and Comparison With Human Immunodeficiency Virus–Negative Cases

Cited by 19 publications

References 11 publications

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls

Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls

Advanced heart failure therapies in patients with stable HIV infection

Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus co‐infection: update in 2013

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