Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection.

Publication Type
Journal Article
Year of Publication
Terrault, Norah A; Roland, Michelle E; Schiano, Thomas; Dove, Lorna; Wong, Michael T; Poordad, Fred; Ragni, Margaret V; Barin, Burc; Simon, David; Olthoff, Kim M; Johnson, Lynt; Stosor, Valentina; Jayaweera, Dushyantha; Fung, John; Sherman, Kenneth E; Subramanian, Aruna; Millis, J Michael; Slakey, Douglas; Berg, Carl L; Carlson, Laurie; Ferrell, Linda; Stablein, Donald M; Odim, Jonah; Fox, Lawrence; Stock, Peter G; Solid Organ Transplantation in HIV: Multi-Site Study Investigators
Liver Transpl
Date Published
2012 Jun
Abdomen, Acute; Adult; Coinfection; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Hepatitis C, Chronic; HIV Infections; Humans; Incidence; kidney transplantation; liver transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors; Survival Analysis; Treatment Outcome; United States

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%, P = 0.21). In conclusion, patient and graft survival rates are lower for HCV/HIV-coinfected LT patients versus HCV-monoinfected LT patients. Importantly, the rates of treated acute rejection (but not the rates of HCV disease severity) are significantly higher for HCV/HIV-coinfected recipients versus HCV-infected recipients. Our results indicate that HCV per se is not a contraindication to LT in HIV patients, but recipient and donor selection and the management of acute rejection strongly influence outcomes.