Liver transplant outcomes in HIV+ haemophilic men

Abstract

Hepatitis C virus infection is the major cause of end-stage liver disease and the major indication for transplantation (OLTX), including among HIV-HCV co-infected individuals. The age of HCV acquisition differs between haemophilic and non-haemophilic candidates, which may affect liver disease outcomes. The purpose of the study was to compare rates of pre- and post-OLTX mortality between co-infected haemophilic and non-haemophilic subjects without hepatocellular cancer participating in the Solid Organ Transplantation in HIV Study (HIV-TR). Clinical variables included age, gender, race, liver disease aetiology, BMI, antiretroviral therapy, MELD score, CD4 + cell count, HIV RNA PCR and HCV RNA PCR. Time to transplant, rejection and death were determined. Of 104 HIV-HCV positive subjects enrolled, 34 (32.7%) underwent liver transplantation, including 7 of 15 (46.7%) haemophilic and 27 of 89 (30.3%) non-haemophilic candidates. Although haemophilic subjects were younger, median 41 vs. 47 years, P = 0.01, they were more likely than non-haemophilic subjects to die pre-OLTX, 5 (33.3%) vs. 13 (14.6%), P = 0.03, and reached MELD = 25 marginally faster, 0.01 vs. 0.7 years, P = 0.06. The groups did not differ in baseline BMI, CD4, detectable HIV RNA, detectable HCV RNA, time to post-OLTX death (P = 0.64), graft loss (P = 0.80), or treated rejection (P = 0.77). The rate of rejection was 14% vs. 36% at 1-year and 36% vs. 43% at 3-year, haemophilic vs. non-haemophilic subjects, respectively, and post-OLTX survival, 71% vs. 66% at 1-year and 38% vs. 53% at 3-year. Despite similar transplant outcomes, pretransplant mortality is higher among co-infected haemophilic than non-haemophilic candidates.

Trial registration: ClinicalTrials.gov NCT00473629.

© 2012 Blackwell Publishing Ltd.

Figures

Figure 1. Post-Transplant Outcomes in HIV-HCV Co-Infected Liver Transplant Recipients

The time to death (1A), graft loss (1B), and rejection (1C) in hemophilic (dashed line) and non-hemophilic transplant recipients (solid line).

Figure 1. Post-Transplant Outcomes in HIV-HCV Co-Infected Liver Transplant Recipients

The time to death (1A), graft loss (1B), and rejection (1C) in hemophilic (dashed line) and non-hemophilic transplant recipients (solid line).

Figure 1. Post-Transplant Outcomes in HIV-HCV Co-Infected Liver Transplant Recipients

The time to death (1A), graft loss (1B), and rejection (1C) in hemophilic (dashed line) and non-hemophilic transplant recipients (solid line).

Figure 2. Pre-Transplant Outcomes in HIV-HCV Co-Infected Hemophilic Liver Transplant Candidates

The time to death (2A), transplantation (2B), and MELD=25 (2C) in hemophilic (dashed line) and in non-hemophilic liver transplant candidates (solid line).

Figure 2. Pre-Transplant Outcomes in HIV-HCV Co-Infected Hemophilic Liver Transplant Candidates

The time to death (2A), transplantation (2B), and MELD=25 (2C) in hemophilic (dashed line) and in non-hemophilic liver transplant candidates (solid line).

Figure 2. Pre-Transplant Outcomes in HIV-HCV Co-Infected Hemophilic Liver Transplant Candidates

The time to death (2A), transplantation (2B), and MELD=25 (2C) in hemophilic (dashed line) and in non-hemophilic liver transplant candidates (solid line).