Survival of Human Immunodeficiency Virus–Infected Liver Transplant Recipients

Human immunodeficiency virus (HIV) infection has been considered an absolute contraindication to solid-organ transplantation. With immune function restoration possible with highly active antiretroviral therapy (HAART), we evaluated 24 HIV-positive subjects with end-stage liver disease who were under...

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Bibliographic Details
Published in:The Journal of infectious diseases 2003-11, Vol.188 (10), p.1412-1420
Main Authors: Ragni, Margaret V., Belle, Steven H., Im, KyungAh, Neff, Guy, Roland, Michelle, Stock, Peter, Heaton, Nigel, Humar, Abhi, Fung, John F.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antiretroviral Therapy, Highly Active
Antiretrovirals
Antivirals
Female
Hepacivirus - growth & development
Hepatitis B - complications
Hepatitis B - virology
Hepatitis B virus - growth & development
Hepatitis C
Hepatitis C - complications
Hepatitis C - virology
highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - surgery
HIV Infections - virology
HIV Protease Inhibitors - therapeutic use
HIV-1 - growth & development
HIV/AIDS
Human immunodeficiency virus
Humans
Immunosuppressive Agents - therapeutic use
Infections
Liver
Liver diseases
Liver Failure - complications
Liver Failure - surgery
Liver Failure - virology
Liver Transplantation
Male
Middle Aged
Prospective Studies
Reverse Transcriptase Inhibitors - therapeutic use
Survival Analysis
Transplantation
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Summary:Human immunodeficiency virus (HIV) infection has been considered an absolute contraindication to solid-organ transplantation. With immune function restoration possible with highly active antiretroviral therapy (HAART), we evaluated 24 HIV-positive subjects with end-stage liver disease who were undergoing orthotopic liver transplantation (OLTX) after the availability of HAART. The cumulative survival among HIV-positive recipients was similar to that among age- and race-comparable HIV-negative recipients (P=.365, by log-rank test). At 12, 24, and 36 months after OLTX, survival was, respectively, 87.1%, 72.8%, and 72.8% among HIV-positive patients, versus 86.6%, 81.6%, and 77.9% among HIV-negative patients. Survival was poorer among subjects with post-OLTX antiretroviral intolerance (P=.044), a post-OLTX CD4+ cell count of 400 copies/mL (P=.016), and hepatitis C virus infection (P=.023). These findings suggest that survival of HIV-positive liver transplant recipients does not differ from that of HIV-negative liver transplant recipients, and they suggest that HIV infection should no longer be a contraindication to OLTX. Further prospective studies are warranted
ISSN:0022-1899
1537-6613
DOI:10.1086/379254