MELD score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates

Abstract

Background & aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates.

Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing.

Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4(+) cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001).

Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4(+) cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Figure 1a. Time to Death in HIV(+) Transplant Candidates. This Kaplan Meier plot shows that time to death is similar in HIV(+) and HIV(−) transplant candidates., p = 0.18. Figure 1b. Time to Transplantation in HIV(+) Transplant Candidates. This Kaplan Meier plot shows time to transplantation is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13. Figure 1c. Time to MELD ≥ 25 in HIV(+) Transplant Candidates. This Kaplan Meier plot shows the time to elevation of MELD to ≥ 25 is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13.

Figure 1

Figure 1a. Time to Death in HIV(+) Transplant Candidates. This Kaplan Meier plot shows that time to death is similar in HIV(+) and HIV(−) transplant candidates., p = 0.18. Figure 1b. Time to Transplantation in HIV(+) Transplant Candidates. This Kaplan Meier plot shows time to transplantation is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13. Figure 1c. Time to MELD ≥ 25 in HIV(+) Transplant Candidates. This Kaplan Meier plot shows the time to elevation of MELD to ≥ 25 is similar in HIV(+) and HIV(−) transplant candidates, p = 0.13.