HIV and Hepatitis.com Coverage of the
13th Annual Conference on Retroviruses and Opportunistic Infections
February 5 - 8, 2006, Denver, CO

4-year Outcome of Liver Transplantation in HIV Patients 

By Marina Nunez, MD, PhD

The outcome of Spanish HIV-infected patients who have undergone orthotopic liver transplantation (OLT) during the HAART era were presented at the 13th CROI.

Fifty patients have been transplanted since the first procedure in January 2002. The reason for end-stage-liver-disease (ESLD) was in all cases hepatitis virus coinfection: HCV in 42 (84%), HBV in 2 (4%) and HCV+HBV in 6 (12%). The median MELD score at the time of transplantation was 15 (IQR 11-17). The series included 7 patients with hepatocellular carcinoma (14%). Most patients were former intravenous drug users (72%).

Median (IQR) follow-up time was 12 (5-24) months. Ten patients have died up to now (20% mortality). Survival (95% CI) at 1, 2, and 3 years were 85% (70% - 93%), 75% (56% - 86%), and 66% (42% - 82%), respectively. Half of the deaths were due to HCV-related liver disease. Pegylated interferon and ribavirin therapy was initiated in 16 cases, and sustained virological response (SVR) was achieved in 2 of 11 evaluable patients (18%).

Acute and chronic rejection occurred in 48% and 10% of patients, respectively. There was no association between graft rejection and a particular immune suppressive regimen (Cyclosporine A- versus tacrolimus-based) One subject required a re-transplantation due to thrombosis in the hepatic artery. Despite use of antiretroviral therapy post-OLT in all cases, HIV progression was experienced by 3 patients (6%). 

In conclusion, in this series of HIV+ OLT patients, with a predominance of former drug users and HCV infection as the cause for ESLD, HCV-reinfection is the major problem after OLT. Other than that, OLT can be considered a safe and effective procedure in the short/mid-term in this population.

02/21/06

Reference
JM Miro and others. Orthotopic liver transplantation in HIV-1 infected patients in Spain: a prospective cohort study of 50 cases. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO. Abstract 875.