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5-Year Survival of HCV/HIV-co-infected Liver Transplant Recipients in Spain:
A Case/Control Study
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Reported y Jules Levin ROI 2009 Montreal Feb 8-12
Jose Miro*1, M Montejo2, L Castells3, J Meneu4, A Rafecas5, M Blanes6, J Fortun7, G De La Rosa8, I Perez1, A Rimola1, and the Spanish OLT in HIV-infected Patients Working Group
1Hosp. Clinic - IDIBAPS. University of Barcelona, Barcelona, Spain; 2Hosp Cruces, Bilbao, Spain; 3Hosp Univ Vall d'Hebron, Barcelona, Spain; 4Hosp 12 de Octubre, Madrid, Spain; 5Hosp Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain; 6Hosp La Fe, Valencia, Spain; 7Hosp Ramon y Cajal, Madrid, Spain; and 8Organizacion Nacional de Trasplante (ONT), Madrid, Spain
Background: Recurrent hepatitis C virus (HCV) after orthotopic liver transplant is a major cause of graft loss and death. Preliminary studies performed in single centers with smaller numbers of patients suggest poorer survival in HCV/HIV-co-infected than in mono-infected patients. This study determined 5-year survival in Spanish HCV/HIV-co-infected and HCV-mono-infected orthotopic liver transplant recipients.
Methods: We included in the study 81 consecutive HCV/HIV-co-infected patients who had undergone orthotopic liver transplant between 2002 and 2006 and followed them until December 2007. Data were obtained from the FIPSE OLT-HIV-05-GESIDA 45-05 database. HIV-infected recipients were matched with 243 HCV-mono-infected patients (1:3 ratio) who had undergone orthotopic liver transplant during the same period in the 17 Spanish institutions that performed orthotopic liver transplant in HIV-infected patients. Other matched criteria were age (±12 years), gender, calendar year (±1 year), same site, hepatitis B virus (HBV) co-infection, and presence of hepatocellular carcinoma. Data for HIV- recipients were obtained from the Spanish Liver Transplant Registry. Differences in continuous variables between the groups were analyzed using Wilcoxon's signed-rank test. Time to graft survival and death was estimated with the Kaplan-Meier method. The equality of the distributions of the times to an event among the groups was estimated using the generalized log-rank test.
Results: During a median 2.6 (1.25 to 3.53) years of follow-up, 29 (35.8%) HCV/HIV-co-infected and 51 (20.9%) HCV-mono-infected patients died. Median age was 42 and 46 years, respectively. Male gender, HBV co-infection and hepatocellular carcinoma were present in 78%, 16%, and 8% in each group. Of the totals, 4 (5%) and 12 (5%) patients needed retransplantation, respectively. Survival (95%CI) rates at 1, 2, 3, 4, and 5 years for HCV/HIV-co-infected and HCV-mono-infected patients were 87.5% (78 to 93) vs 89.1% (84.4 to 92.4), 70.8% (59 to 79.8) vs 75.9% (75.8 to 86.2), 61.8% (48.3 to 72.7) vs 77.4% (71 to 82.3), 58.3% (43.9 to 70.3) vs 76.2% (70 to 81.9), and 47.9% (30 to 63.7) vs 75.1% (67.8 to 80.9), respectively (p <0.01). Graft survival rates at 1, 3, and 5 years for HCV/HIV-co-infected and HCV-mono-infected patients were 77% (66 to 85) vs 85% (81 to 90), 52% (36 to 66) vs 76% (70 to 81), and 37% (20 to 55) vs 67% (58 to 75), respectively (p <0.01).
Conclusions: Short-term patient and graft survival in HCV/HIV orthotopic liver transplant co-infected patients was similar to that of HCV mono-infected orthotopic liver transplant recipients. However, mid- to long-term survival was poorer in HCV/HIV-co-infected patients.
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