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Outcomes of Liver Transplant Recipients with Hepatitis C and Human Immunodeficiency Virus Coinfection


Journal Article

Terrault, N.A.; Roland, M.E.; Schiano, T.; Dove, L.; Wong, M.; Poordad, F.; Ragni, M.V.; Barin, B.; Simon, D.; Olthoff, K.M.; Johnson, L.; Stosor, V.; Jayaweera, D.; Fung, J.; Sherman, K.E.; Subramanian, A.; Millis, J.; Slakey, D.; Berg, C.; Carlson, L.; Ferrell, L.; Stablein, D.

Liver Transpl




Graft Survival; HCV; HCV/HIV; HIV; kidney-liver transplantation; liver transplantation; Multi-center study

{Hepatitis C virus (HCV) is a controversial indication for liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients because of reportedly poor outcomes. This prospective, multicenter US cohort study compared patient and graft survival for 89 HCV/HIV-coinfected patients and 2 control groups: 235 HCV-monoinfected LT controls and all US transplant recipients who were 65 years old or older. The 3-year patient and graft survival rates were 60% [95% confidence interval (CI) = 47%-71%] and 53% (95% CI = 40%-64%) for the HCV/HIV patients and 79% (95% CI = 72%-84%) and 74% (95% CI = 66%-79%) for the HCV-infected recipients (P < 0.001 for both), and HIV infection was the only factor significantly associated with reduced patient and graft survival. Among the HCV/HIV patients, older donor age [hazard ratio (HR) = 1.3 per decade], combined kidney-liver transplantation (HR = 3.8), an anti-HCV-positive donor (HR = 2.5), and a body mass index < 21 kg/m(2) (HR = 3.2) were independent predictors of graft loss. For the patients without the last 3 factors, the patient and graft survival rates were similar to those for US LT recipients. The 3-year incidence of treated acute rejection was 1.6-fold higher for the HCV/HIV patients versus the HCV patients (39% versus 24%, log rank P = 0.02), but the cumulative rates of severe HCV disease at 3 years were not significantly different (29% versus 23%

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