Liver transplant outcomes in HIV+ haemophilic men.
2013 Jan
Journal Article
Authors:
Ragni, M.V.;
Devera, M.E.;
Roland, M.E.;
Wong, M.;
Stosor, V.;
Sherman, K.E.;
Hardy, D.;
Blumberg, E.;
Fung, J.;
Barin, B.;
Stablein, D.;
Stock, P.G.
Secondary:
Haemophilia
Volume:
19
Pagination:
134-40
Issue:
1
PMID:
22762561
DOI:
10.1111/j.1365-2516.2012.02905.x
Keywords:
Adult; Coinfection; Hemophilia A; Hepatitis C, Chronic; HIV Infections; Humans; Liver Failure; liver transplantation; Male; Middle Aged; Proportional Hazards Models
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.
