Michelle E Roland1, Burc Barin, Shirish Huprikar, Barbara Murphy, Douglas W Hanto, Emily Blumberg, Kim Olthoff, David Simon, William D Hardy, George Beatty, Peter G Stock. 1. aDepartment of Medicine, University of California, San Francisco, San Francisco, CaliforniabEMMES Corporation, Rockville, MarylandcIcahn School of Medicine at Mount Sinai, New York, New YorkdBeth Israel Deaconess Medical Center, Boston, MassachusettseUniversity of Pennsylvania, Philadelphia, PennsylvaniafRush University Medical Center, Chicago, IllinoisgDavid Geffen School of Medicine, UCLA and Cedars Sinai Medical Center, Los AngeleshDepartment of Surgery, University of California, San Francisco, San Francisco, California, USA.*Douglas W. Hanto's current affiliation is Vanderbilt University, Nashville, TN, USA.†George Beatty current affiliation is California Department of Corrections and Rehabilitation, California, USA.
Abstract
OBJECTIVES: To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients. DESIGN: Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls. METHODS: We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models. RESULTS: There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P < 0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P = 0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P = 0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P = 0.07) and HR 1.4 (P = 0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis. CONCLUSION: Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest. TRIAL REGISTRATION: ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.
OBJECTIVES: To evaluate the impact of liver and kidney transplantation on survival in HIV-positive transplant candidates and compare outcomes between HIV-positive and negative recipients. DESIGN: Observational cohort of HIV-positive transplant candidates and recipients and secondary analysis comparing study recipients to HIV-negative national registry controls. METHODS: We fit proportional hazards models to assess transplantation impact on mortality among recipients and candidates. We compared time to graft failure and death with HIV-negative controls in unmatched, demographic-matched, and risk-adjusted models. RESULTS: There were 17 (11.3%) and 46 (36.8%) deaths among kidney and liver recipients during a median follow-up of 4.0 and 3.5 years, respectively. Transplantation was associated with survival benefit for HIV-infected liver recipients with model for end-stage liver disease (MELD) greater than or equal 15 [hazard ratio (HR) 0.1; 95% confidence interval (CI) 0.05, 0.01; P < 0.0001], but not for MELD less than 15 (HR 0.7; 95% CI 0.3, 1.8; P = 0.43) or for kidney recipients (HR 0.6; 95% CI 0.3, 1.4; P = 0.23). In HIV-positive kidney recipients, unmatched and risk-matched analyses indicated a marginally significant HR for graft loss [1.3 (P = 0.07) and HR 1.4 (P = 0.052)]; no significant increase in risk of death was observed. All models demonstrated a higher relative hazard of graft loss or death in HIV-positive liver recipients; the absolute difference in the proportion of deaths was 6.7% in the risk-matched analysis. CONCLUSION: Kidney transplantation should be standard of care for well managed HIV-positive patients. Liver transplant in candidates with high MELD confers survival benefit; transplant is a viable option in selected candidates. The increased mortality risk compared with HIV-negative recipients was modest. TRIAL REGISTRATION: ClinicalTrials.Gov; NCT00074386; http://clinicaltrials.gov/.
Authors: C S Coffin; P G Stock; L M Dove; C L Berg; N N Nissen; M P Curry; M Ragni; F G Regenstein; K E Sherman; M E Roland; N A Terrault Journal: Am J Transplant Date: 2010-03-19 Impact factor: 8.086
Authors: Colette J Smith; Lene Ryom; Rainer Weber; Philippe Morlat; Christian Pradier; Peter Reiss; Justyna D Kowalska; Stephane de Wit; Matthew Law; Wafaa el Sadr; Ole Kirk; Nina Friis-Moller; Antonella d'Arminio Monforte; Andrew N Phillips; Caroline A Sabin; Jens D Lundgren Journal: Lancet Date: 2014-07-19 Impact factor: 79.321
Authors: Amanda Mocroft; Peter Reiss; Jacek Gasiorowski; Bruno Ledergerber; Justyna Kowalska; Antonio Chiesi; Jose Gatell; Aza Rakhmanova; Margaret Johnson; Ole Kirk; Jens Lundgren Journal: J Acquir Immune Defic Syndr Date: 2010-10 Impact factor: 3.731
Authors: M Touzot; E Pillebout; M Matignon; L Tricot; J P Viard; E Rondeau; C Legendre; D Glotz; M Delahousse; P Lang; M N Peraldi Journal: Am J Transplant Date: 2010-09-14 Impact factor: 8.086
Authors: A G Chapuis; G Paolo Rizzardi; C D'Agostino; A Attinger; C Knabenhans; S Fleury; H Acha-Orbea; G Pantaleo Journal: Nat Med Date: 2000-07 Impact factor: 53.440
Authors: Robert M Merion; Douglas E Schaubel; Dawn M Dykstra; Richard B Freeman; Friedrich K Port; Robert A Wolfe Journal: Am J Transplant Date: 2005-02 Impact factor: 8.086
Authors: Ayla Cash; Xun Luo; Eric K H Chow; Mary Grace Bowring; Ashton A Shaffer; Brianna Doby; Corey E Wickliffe; Charles Alexander; Deborah McRann; Aaron A R Tobian; Dorry L Segev; Christine M Durand Journal: Clin Transplant Date: 2018-01-16 Impact factor: 2.863
Authors: Brian J Boyarsky; Mary Grace Bowring; Ashton A Shaffer; Dorry L Segev; Christine M Durand Journal: Curr Opin Organ Transplant Date: 2019-08 Impact factor: 2.640
Authors: Elmi Muller; Francois C J Botha; Zunaid A Barday; Kathryn Manning; Peter Chin-Hong; Peter Stock Journal: Transplantation Date: 2021-07-01 Impact factor: 5.385
Authors: Timothy J Henrich; Corinna Schreiner; Cheryl Cameron; Louise E Hogan; Brian Richardson; Rachel L Rutishauser; Amelia N Deitchman; Simon Chu; Rodney Rogers; Cassandra Thanh; Erica A Gibson; Arya Zarinsefat; Sonia Bakkour; Francesca Aweeka; Michael P Busch; Teri Liegler; Christopher Baker; Jeffrey Milush; Steven G Deeks; Peter G Stock Journal: Am J Transplant Date: 2020-09-15 Impact factor: 9.369