MELD score is an important predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

Publication Type
Journal Article
Year of Publication
Subramanian, Aruna; Sulkowski, Mark; Barin, Burc; Stablein, Donald; Curry, Michael; Nissen, Nicholas; Dove, Lorna; Roland, Michelle; Florman, Sander; Blumberg, Emily; Stosor, Valentina; Jayaweera, D T; Huprikar, Shirish; Fung, John; Pruett, Timothy; Stock, Peter; Ragni, Margaret
Date Published
2010 Jan
Adult; Cohort Studies; Female; Hepatitis C, Chronic; HIV Infections; Humans; Liver Failure; liver transplantation; Male; Middle Aged; Predictive Value of Tests; Preoperative Care; Reproducibility of Results; Risk Factors; Severity of Illness Index; Waiting Lists

BACKGROUND & AIMS: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates.

METHODS: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing.

RESULTS: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4(+) cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001).

CONCLUSIONS: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4(+) cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.