1. Liver transplant outcomes in HIV(+) haemophilic men
- Author
-
Ragni, MV, DeVera, ME, Roland, ME, Wong, M, Stosor, V, Sherman, KE, Hardy, D, Blumberg, E, Fung, J, Barin, B, Stablein, D, and Stock, PG
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Immunology ,Liver Disease ,Infectious Diseases ,Organ Transplantation ,Transplantation ,Digestive Diseases ,Chronic Liver Disease and Cirrhosis ,Emerging Infectious Diseases ,HIV/AIDS ,Hepatitis ,Hepatitis - C ,Clinical Research ,Infection ,Good Health and Well Being ,Adult ,Coinfection ,HIV Infections ,Hemophilia A ,Hepatitis C ,Chronic ,Humans ,Liver Failure ,Liver Transplantation ,Male ,Middle Aged ,Proportional Hazards Models ,haemophilia ,hepatitis C liver disease ,HIV-HCV co-infection ,liver transplantation ,Clinical Sciences ,Cardiovascular System & Hematology ,Clinical sciences - Abstract
Hepatitis C virus infection is the major cause of end-stage liver disease and the major indication for transplantation (OLTX), including among HIV-HCV co-infected individuals. The age of HCV acquisition differs between haemophilic and non-haemophilic candidates, which may affect liver disease outcomes. The purpose of the study was to compare rates of pre- and post-OLTX mortality between co-infected haemophilic and non-haemophilic subjects without hepatocellular cancer participating in the Solid Organ Transplantation in HIV Study (HIV-TR). Clinical variables included age, gender, race, liver disease aetiology, BMI, antiretroviral therapy, MELD score, CD4 + cell count, HIV RNA PCR and HCV RNA PCR. Time to transplant, rejection and death were determined. Of 104 HIV-HCV positive subjects enrolled, 34 (32.7%) underwent liver transplantation, including 7 of 15 (46.7%) haemophilic and 27 of 89 (30.3%) non-haemophilic candidates. Although haemophilic subjects were younger, median 41 vs. 47 years, P = 0.01, they were more likely than non-haemophilic subjects to die pre-OLTX, 5 (33.3%) vs. 13 (14.6%), P = 0.03, and reached MELD = 25 marginally faster, 0.01 vs. 0.7 years, P = 0.06. The groups did not differ in baseline BMI, CD4, detectable HIV RNA, detectable HCV RNA, time to post-OLTX death (P = 0.64), graft loss (P = 0.80), or treated rejection (P = 0.77). The rate of rejection was 14% vs. 36% at 1-year and 36% vs. 43% at 3-year, haemophilic vs. non-haemophilic subjects, respectively, and post-OLTX survival, 71% vs. 66% at 1-year and 38% vs. 53% at 3-year. Despite similar transplant outcomes, pretransplant mortality is higher among co-infected haemophilic than non-haemophilic candidates.
- Published
- 2013