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HIV-Infected Liver and Kidney Transplant Recipients: 1- and 3-Year Outcomes


Journal Article

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.

Am J Transplant




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

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.

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