Surgical Complications in 275 HIV-Infected Liver and/or Kidney Transplantation Recipients
09/2012
Journal Article
Authors:
Harbell, J.;
Fung, J.;
Nissen, N.;
Olthoff, K.;
Florman, S.;
Hanto, D.;
Light, J.;
Bartlett, S.;
Tzakis, A.;
Pearson, T.;
Barin, B.;
Roland, M.;
Stock, P.
Secondary:
Surgery
Volume:
152
Pagination:
376-381
URL:
http://www.ncbi.nlm.nih.gov/pubmed/22938898
Keywords:
Anastomotic Leak/epidemiology; Graft Survival; HIV Infections/epidemiology/surgery; Intraoperative Complications/epidemiology; Kidney Transplantation/mortality/statistics & numerical data; Liver Transplantation/mortality/statistics & numerical data
Abstract:
BACKGROUND: In this report, we examine the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplantation (TX) recipients in a prospective nonrandomized U.S. multicenter trial. METHODS: Subjects were required to have CD4(+) T-cell counts >200/100 cells/mm(3) (K/L) and undetectable plasma HIV-1 RNA (Viral Load [VL]) (K) or expected posttransplantation suppression (L). Impact of SCs (N ≥ 7) was evaluated by use of the proportional hazards models. Baseline morbidity predictors for SCs (N ≥ 7) were assessed in univariate proportional hazards models. RESULTS: At median 2.7 (interquartile range 1.9-4.1) and 2.3 (1.0-3.7) years after TX, 3-month and 1-year graft survival were [K] 96% (95% CI 91%-98%) and 91% (95% CI 85%-94%) and [L] 91% (95% CI 85%-95%) and 77% (95% CI 69%-84%), respectively. A total of 14 K and 28 L graft losses occurred in the first year; 6 K and 11 L were in the first 3 months. A total of 26 (17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (hazard ratio [HR] 2.8; 95% CI 1.0-8.4; P = .06) with increased risk of graft loss, whereas a greater MELD score before transplantation (HR 1.07 per point increase; 95% CI: 1.01-1.14; P = .02), and detectable viral load before TX (HR 3.6; 95% CI 0.9-14.6; P = .07) was associated with an increased risk of wound infections/dehiscence. CONCLUSION: The rates and outcomes of surgical complications are similar to what has been observed in the non-HIV setting in carefully selected HIV-infected liver and kidney TX recipients
