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HIV positive and HIV negative patients
have similar survival rates following liver transplant
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Copenhagen, Denmark, Friday 24 April: HIV positive and HIV negative patients have comparable survival rates following liver transplant, according to new research presented today at EASL 2009, the Annual Meeting of the European Association for the Study of Liver in Copenhagen, Denmark.
The study results showed no difference in survival rates at 1 and 5 years between HIV negative and HIV positive patients (86.5% and 74% versus 87.1% and 78%, p=0.843), suggesting a good prognosis for HIV positive patients following liver transplant. However, the study confirmed that co-infection with hepatitis C virus (HCV) is a significant predictor of poorer survival rates in patients with HIV. Survival rates at 1 and 5 years were 73% and 53% in HIV positive patients with hepatitis C versus 87% and 69% (p=0.047) in HIV negative patients with hepatitis C.
Doctor Kosh Agarwal, of the Institute of Liver Studies, Kings College Hospital, London, who led the study said: "Data on long term outcomes from liver transplantation in HIV patients is limited. These study results are valuable confirmation that selected HIV positive patients are as suitable candidates for liver transplant as HIV negative patients and should have similar access to treatment. However, those patients with co-infection with hepatitis C did less well, emphasising the need for appropriate antiviral therapy early in the course of their HCV related liver disease. In the context of co-infection, these data emphasise the need to develop newer and more innovative treatment strategies. These should include exposure to new small molecule therapies for HCV that are currently being explored in mono-infection."
The researchers conducted a prospective analysis of the UK Transplant Database to determine the long-term outcomes in HIV patients undergoing liver transplant in the UK. They examined 6,315 adult patients (>18 years) undergoing their first liver transplant between March 1994 and April 2008. The patient groups compared in this analysis included:
1. HIV positive patients who tested negative for both hepatitis C and hepatitis B
2. HIV negative patients with hepatitis C
3. HIV positive patients with hepatitis C
The three patient groups were comparable according to the Model End Stage Liver Disease (MELD) scores, which is a numerical scale to score disease severity and improve organ allocation in transplantation. HIV positive patients were younger compared to HIV negative patients (mean 42.2 years versus 51.2, p=0.001) and HIV positive patients co-infected with hepatitis C were younger (mean 39.9 years versus 51.8; p=0.0001) than HIV negative patients with hepatitis C.
UK LIVER TRANSPLANT EXPERIENCE OF HIV: LONG TERM OUTCOMES
D. Joshi1, V. Aluvihare1, A. Belgaumkar1, A. Suddle1, P. Pocock2, M.A. Heneghan1, J. O'Grady1, K. Agarwal1
1Institute of Liver Studies, King's College Hospital, London, 2Statistics and Audit Directorate, UK Transplant, Bristol, UK
Background: Experience in liver transplantation (LT) in HIV+ patients is limited. Recent reports suggest that HCV co-infection is associated with shorter survival in HIV+ patients post-LT.
Methods and aims: The prospective UK Transplant database was analysed to determine the long term outcomes in HIV+ patients undergoing LT in the UK. Adult (>18 years) patients undergoing first cadaveric LT (March 1994 and April 2008) were included. The following groups were compared: [HIV+/HCV], [HIV+/Other] and HCV mono-infection [HCV].
Results: 33 HIV+ (29 male; 0.6% of total LT activity), 847 [HCV] (15 % of LT activity) and 5435 HIV- patients underwent LT during the study period. Of the 33 HIV+ patients 16 were HCV Ab positive[HIV+/HCV], 6 were HBsAg positive and 11 were neither HCV Ab nor HBsAg positive [HIV+/Other].
HIV+ patients were younger compared to HIV- patients (mean 42.2 years ± 9 versus 51.2 ± 11.06; p=0.001) and had poorer mean survival rates post-LT (44 months ± 32 versus 57.1 ± 0.4; p=0.0001).[HIV+/HCV] were younger (mean 39.9 years ± 7 versus 51.8 ± 8,3; p=0.0001) and had significantly lower mean survival (29 ± 28.2 versus 47.7 ± 35.4; p=0.04) compared to [HCV]. MELD scores were comparable between the 3 groups.
Compared with the [HCV] group, survival rates at 1 and 5 years differed significantly in the HIV+ patients (73% and 53% [HIV+/HCV] versus 100% and 100% [HIV+/Other] versus 87% and 69% [HCV], Log rank test, p=0.04). No difference in survival rates at 1 and 5 years was demonstrated between the HIV- and HIV+ groups (86.5% and 74% versus 87.1% and 78%, p=0.843)..
Univariate analysis demonstrated that HCV infection was a significant predictor of death after LT in HIV+ patients (OR 10, 95% CI 1.03 to 97.04, p=0.047). In a multivariate logistic regression model, using HCV co-infection, MELD score, recipient and donor ages to predict survival,the effect of HCV co-infection was not independent of the other co-variates (OR 8.8, 95% CI 0.66 to 118.9, p=0.612).
Conclusion: Our data suggests that HIV+ patients have a good prognosis post-LT. Survival in [HIV+/HCV] co-infected patients is significantly worse compared to [HCV] and [HIV+/Other] patients.
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