HIV-Infected Liver and Kidney Transplant Recipients: 1- and 3-Year Outcomes
Year of Publication
Roland, M; Barin, B; Carlson, L; Frassetto, L; Terrault, N; Hirose, R; Freise, C; Benet, L; Ascher, N; Roberts, J; Murphy, B; Keller, M; Olthoff, K; Blumberg, E; Brayman, K; Bartlett, J; Davis, C; McCune, J; Bredt, B; Stablein, D; Stock, P
Am J Transplant
Adult; Antiretroviral Therapy-Highly Active; Cadaver; CD4 Lymphocyte Count; Female; Follow-Up Studies; Graft Rejection; HIV Infections; kidney transplantation; liver transplantation; Living Donors; Male; Middle Aged; Tissue Donors; Treatment Outcomes
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.
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