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Spanish Cohort of HIV+ Patients with Orthotopic Liver Transplantation (OLT): Evaluation of 50 Cases in HAART Era (2002-05)
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Reported by Jules Levin
At the 2nd Intl HIV and Hepatitis Coinfection Workshop in Amsterdam (Jan 12-14, 2005), Jose Miro provided a preview of his presentation at CROI 2006 on liver transplantation in HIV+ individuals in Spain.
There have been 50 OLTs from Jan 2002 through Oct 2005 in HIV+ patients.
The most prominent cause of liver cirrhosis was HCV (42 patients (84%)) and also included 2 due to HBV (4%), and 6 with HBV+HCV (12%). Seven patients (14%) had HCC. Four patients had alcohol use. Most patients had genotype 1 (57%). Three cases had a non-typable genotype, and there were 3 cases of Delta coinfection.
3 patients had Child-Pugh stage A (6%); 25 patients had B (50%); and 22 cases (44%) had C.
The median MELD was 15 (11-17).
80% were men. Average age was 40 (38-45). 72% were IVDUs, 12% sexual risk factor (heterosexuals, 3 homosexuals), 8% hemophilia, and 8% other.
Before transplantation the ART regimens patients were taking were: EFV HAART 24 (48%), PI-based HAART 12 (24%), 3-4 NRTI-based abacavir based regimen 8 (16%), other combinations 6 (12%). Average CD4 count was 275. 44 (88%) patients had <200 copies/ml viral load.
The average time on the waiting list was 3 months (2-7). Type of liver they received: cadaveric 96%; living-donor 4%. Moratlity: 10 died (20%). The followup is an average of 12 months (5-24), 2 patients required retransplantation.
MORTALITY
Early mortality (<3 mos), 4 (40%): 3 post-op. complications; 1 massive variceal bleeding.
Late mortality (>9 mos) 6 (60%): 5 graft ELSD- HCV reinfection; 1 chronic reinfection.
Kaplan-Meier estimates of Survival:
85% (70-93%) at 1 year
75% (56-86%) at 2 years
66% (42-82%) at 3 year.
Comparing HIV- & HIV+ there was no statistical difference.
Post-Op Complications (n=50)
Hospitalization stay: 19 days (14-29)
Surgical Complications
- Biliary fistula 3 (8%)
- Peritoncal hemorrhafe 3 (8%)
- steatosis of hepatic artery 2 (6%)
other complications 2 (6%)
Immunosuppressive Regimens
Cyclosporine A (CsA)
Prednisone, or 7 (14%) IL-2
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