HIV-Infected Liver and Kidney Transplant Recipients: 1- and 3-Year Outcomes
02/2008
Journal Article
Authors:
Roland, M.;
Barin, B.;
Carlson, L.;
Frassetto, L.;
Terrault, N.;
Hirose, R.;
Freise, C.;
Benet, L.;
Ascher, N.;
Roberts, J.;
Murphy, B.;
Keller, M.;
Olthoff, K.;
Blumberg, E.;
Brayman, K.;
Bartlett, J.;
Davis, C.;
McCune, J.;
Bredt, B.;
Stablein, D.;
Stock, P.
Secondary:
Am J Transplant
Volume:
8
Pagination:
355-365
URL:
http://www.ncbi.nlm.nih.gov/pubmed/18093266
Keywords:
Adult; Antiretroviral Therapy-Highly Active; Cadaver; CD4 Lymphocyte Count; Female; Follow-Up Studies; Graft Rejection; HIV Infections; kidney transplantation; liver transplantation; Living Donors; Male; Middle Aged; Tissue Donors; Treatment Outcomes
Abstract:
Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.
