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, A. Jain, J. J. Fung, M. V. Ragni

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127 Scopus citations

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 2006

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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