HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes.

Publication Type
Journal Article
Year of Publication
Roland, M E; Barin, B; Carlson, L; Frassetto, L A; Terrault, N A; Hirose, R; Freise, C E; Benet, L Z; Ascher, N L; Roberts, J P; Murphy, B; Keller, M J; Olthoff, K M; Blumberg, E A; Brayman, K L; Bartlett, S T; Davis, C E; McCune, J M; Bredt, B M; Stablein, D M; Stock, P G
Am J Transplant
Date Published
2008 Feb
Adult; Antiretroviral Therapy, Highly Active; Cadaver; CD4 Lymphocyte Count; Female; Follow-Up Studies; Graft Rejection; HIV Infections; Humans; kidney transplantation; liver transplantation; Living Donors; Male; Middle Aged; Time Factors; Tissue Donors; Treatment Outcome; Viral Load

Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.