Beyond the NIH Multicenter HIV Transplant Trial Experience: Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Coinfected Recipients in the United States
The effectiveness of liver transplant (LT) in HIV and HIV/HCV co-infected recipients in the US is unknown. We investigated (i) the effect of HIV on US patient and allograft LT outcomes, compared to HCV+ and HIV/HCV uninfected recipients and (ii) whether LT at centers that participated in the NIH Solid Organ Transplantation in HIV Trial, reflecting experience and a standardized approach to patient selection, impacted outcomes.
A retrospective cohort study of primary LT recipients transplanted February 27, 2002 through December 31, 2013, categorized by serostatus: HCV+ (n=20,829), HIV+ (n=72), HIV+/HCV+ (n=160) and HIV-/HCV- uninfected (n=22,926) as reference. Survival was determined using Cox regression, stratified according to center NIH trial participation.
HCV (HR 1.46, 95%CI 1.41-1.52) and HIV/HCV co-infection (HR 2.62, 95% CI 2.06-3.33) were associated with mortality; HIV mono-infection was not (HR 1.37, 95% CI 0.86-2.18). This was unchanged after stratification on NIH trial participation, although mortality was higher in NIH-enrolling (HIV+: HR 1.65, 95% CI 0.93-2.92; HIV+/HCV+: HR 3.15, 95% CI 2.32-4.28) than in non-enrolling centers (HIV+: HR 1.03, 95% CI 0.43-2.47, HIV+/HCV+: HR 2.55, 95% CI 1.64-3.96). While allograft loss was higher in HIV/HCV co-infected recipients transplanted at enrolling (HR 2.64, 9%% CI 1.91-3.64) versus non-enrolling centers (HR 2.22, 95% CI 1.41-3.49), there was no difference in HIV and HCV mono-infected patients.
HIV+ LT recipient outcomes were superior to HCV+ or HIV/HCV co-infected recipients. Despite a standardized approach and plausibly more experience with HIV patients, transplantation at NIH study center did not improve outcomes.
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 September 2024.
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