Pre-transplant Survival Is Shorter in HIV Positive than in HIV
Negative Patients and Is Unrelated to Severity of Liver or HIV
Disease
Although HIV positive individuals on HAART have shown improved survival
rates after liver
transplantation (OLTX)
compared to the pre-HAART era, some transplant candidates do not
survive to OLTX.
In the present study, researchers at the University of Pittsburgh
School of Medicine sought to determine if pre-transplant outcome
is related to severity of liver disease and/or HIV infection.
Results
The investigators prospectively
evaluated 58 consecutive HIV-positive candidates seen at a single
center from 1997-2002.
Of the
58, 15 (25.9%) were transplanted, whereas 21 (36.2%) died before
OLTX, a median one month of evaluation, with more than half of
those (12 of 21, 57.1%) dying from infection.
By
contrast, of 1,359 HIV-negative candidates, 860 (63.3%) were transplanted,
whereas 211 (15.5%) died before OLTX (P < 0.001).
The
cumulative survival following initial evaluation was significantly
shorter among HIV-positive than HIV-negative candidates (880 vs.
1,427 days, P = 0.035, Breslow) but was not related to the initial
pre-transplant MELD score (16 vs. 15), INR (1.5 vs. 1.5),
creatinine (1.3 vs. 1.3 mg/dL), or total bilirubin (6.6 vs.
5.7 mg/dL), respectively, all P > 0.05.
Among
untransplanted HIV-positive candidates, the 21 who died did not
differ from the 22 surviving in initial MELD (15 vs. 13), CD4
(230 vs. 327/muL), HIV load (both < 400 copies/mL), HAART intolerance
(10/21, 47.6% vs. 10/22, 45.4%), or HCV infection (16/21, 76.2%
vs. 16/22, 72.3%), all P > 0.05.
Further,
the 21 did not differ from the 15 transplanted in pre-OLTX CD4,
HIV load, or MELD score, all P > 0.05.
In
conclusion, pre-transplant survival appears shorter in HIV-positive
OLTX candidates and is unrelated to severity of liver or HIV disease.
“Further
study is warranted to determine risk factors for poorer pre-transplant
outcomes,” write the study authors.
Department of Medicine, University of Pittsburgh
School of Medicine,
Pittsburgh,
PA.
10/31/05
Reference
M V Ragni and others. Pre-transplant survival is shorter in HIV-positive
than HIV-negative subjects with end-stage liver disease. Liver Transplantation 11(11): 1425-1430. October 19, 2005.
