Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls
Michelle E Roland, Burc Barin, Shirish Huprikar, Barbara Murphy, Douglas W Hanto, Emily Blumberg, Kim Olthoff, David Simon, William D Hardy, George Beatty, Peter G Stock, HIVTR Study Team, Laurie Carlson, Norah A Terrault, Rodney L Rogers, Thomas D Schiano, Michael Wong, Robert Redfield, Charles Davis, Michael Yin, Lorna Dove, Shmuel Shoham, Aruna Subramanian, Jimmy A Light, Margaret Ragni, Joseph Timpone, Valentina Stosor, Dushyantha T Jayaweera, Fred Poordad, Nicholas Nissen, Brian Wispelway, Kenneth Pursell, David Mushatt, Thomas C Pearson, Judith Feinberg, Kenneth E Sherman, Alan J Taege, Jeffrey M Jacobson, Brigid Betz-Stablein, Don Stablein, Lawrence Fox, Jonah Odim, Michelle E Roland, Burc Barin, Shirish Huprikar, Barbara Murphy, Douglas W Hanto, Emily Blumberg, Kim Olthoff, David Simon, William D Hardy, George Beatty, Peter G Stock, HIVTR Study Team, Laurie Carlson, Norah A Terrault, Rodney L Rogers, Thomas D Schiano, Michael Wong, Robert Redfield, Charles Davis, Michael Yin, Lorna Dove, Shmuel Shoham, Aruna Subramanian, Jimmy A Light, Margaret Ragni, Joseph Timpone, Valentina Stosor, Dushyantha T Jayaweera, Fred Poordad, Nicholas Nissen, Brian Wispelway, Kenneth Pursell, David Mushatt, Thomas C Pearson, Judith Feinberg, Kenneth E Sherman, Alan J Taege, Jeffrey M Jacobson, Brigid Betz-Stablein, Don Stablein, Lawrence Fox, Jonah Odim
Abstract
Objectives: To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients.
Design: Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls.
Methods: We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models.
Results: There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P < 0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P = 0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P = 0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P = 0.07) and HR 1.4 (P = 0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis.
Conclusion: Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest.
Trial registration: ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.
Conflict of interest statement
Conflicts of interest
The authors of this manuscript have no conflicts of interest to disclose.
Source: PubMed