Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C

M. E. De Vera, I. Dvorchik, K. Tom, B. Eghtesad, N. Thai, O. Shakil, A. Marcos, A. Demetris, Ashokkumar Jain, J. J. Fung, M. V. Ragni

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Abstract

Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled posttransplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95%CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score >20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA >30 000 000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-α/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.

Original languageEnglish (US)
Pages (from-to)2983-2993
Number of pages11
JournalAmerican Journal of Transplantation
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2006

Fingerprint

Hepatitis C
Hepacivirus
HIV
Transplants
Liver
End Stage Liver Disease
Highly Active Antiretroviral Therapy
Survival
RNA
Ribavirin
African Americans
Liver Transplantation
Interferons
Hepatitis
HIV Infections
Fibrosis
Mortality

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

De Vera, M. E. ; Dvorchik, I. ; Tom, K. ; Eghtesad, B. ; Thai, N. ; Shakil, O. ; Marcos, A. ; Demetris, A. ; Jain, Ashokkumar ; Fung, J. J. ; Ragni, M. V. / Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. In: American Journal of Transplantation. 2006 ; Vol. 6, No. 12. pp. 2983-2993.
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abstract = "Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled posttransplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7{\%}, 55.6{\%} and 33.3{\%} versus 75.7{\%}, 71.6{\%} and 71.6{\%}, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95{\%}CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score >20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA >30 000 000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-α/ribavirin, six (40{\%}) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.",
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De Vera, ME, Dvorchik, I, Tom, K, Eghtesad, B, Thai, N, Shakil, O, Marcos, A, Demetris, A, Jain, A, Fung, JJ & Ragni, MV 2006, 'Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C', American Journal of Transplantation, vol. 6, no. 12, pp. 2983-2993. https://doi.org/10.1111/j.1600-6143.2006.01546.x

Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. / De Vera, M. E.; Dvorchik, I.; Tom, K.; Eghtesad, B.; Thai, N.; Shakil, O.; Marcos, A.; Demetris, A.; Jain, Ashokkumar; Fung, J. J.; Ragni, M. V.

In: American Journal of Transplantation, Vol. 6, No. 12, 01.12.2006, p. 2983-2993.

Research output: Contribution to journalArticle

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T1 - Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C

AU - De Vera, M. E.

AU - Dvorchik, I.

AU - Tom, K.

AU - Eghtesad, B.

AU - Thai, N.

AU - Shakil, O.

AU - Marcos, A.

AU - Demetris, A.

AU - Jain, Ashokkumar

AU - Fung, J. J.

AU - Ragni, M. V.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled posttransplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95%CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score >20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA >30 000 000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-α/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.

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