Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients.

Publication Type
Journal Article
Year of Publication
Harbell, Jack; Fung, John; Nissen, Nicholas; Olthoff, Kim; Florman, Sander S; Hanto, Douglas W; Light, Jimmy; Bartlett, Steve T; Tzakis, Andreas G; Pearson, Thomas C; Barin, Burc; Roland, Michelle E; Stock, Peter G; HIV-TR Investigators
Date Published
2012 Sep
Anastomotic Leak; Graft Survival; HIV Infections; Humans; Intraoperative Complications; kidney transplantation; liver transplantation; Postoperative Complications; Proportional Hazards Models; Prospective Studies; Reoperation; Surgical Wound Dehiscence; Surgical Wound Infection; Survival Rate; Transplantation; Viral Load

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/mm3 (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.