HIV-Related Predictors and Outcomes in 275 Liver and/or Kidney Transplant Recipients (oral presentation)

Publication Type
Conference Paper
Year of Publication
2011
Authors
Roland, M; Barin, B; Huprikar, S; Wong, M; Fox, L; Diego, J; Blumberg, E; Simon, D; Shoham, S; Stock, P
Secondary
American Transplant Congress
Date Published
04/2011
Location
Philadelphia, PA
Keywords
HIV virus; infection; kidney transplantation; liver transplantation
Abstract
Introduction: We describe survival & infections among 125 liver (L) & 150 kidney (K) transplants (TX).Methods: Subjects had CD4 >200/100 (K/L) & undetectable HIV RNA (VL; K) or expected control (L). Baseline (BL) mortality predictors in proportional hazards (PH) models: age, sex, race, CD4 nadir/study enroll/pre-TX (per 50 cells/µL), VL enroll/pre-TX [L], HCV, dual L/K TX [L], MELD pre-TX [L], BMI enroll/pre-TX, initial thymoglobulin (thymo) [K], opportunistic infection (OI) history, donor HCV/age/marginal [L]. Impact of TX on survival PH models: same as above - pre-TX, donor factors, thymo + TX, CD4, VL, MELD as time-dependant covariates (TDC). We describe prior/post-TX OI. Predictors of first non-OI serious infection (SI) PH models: same as above - donor + CD4, VL, sirolimus, thymo [K] as TDC. Multivariate PH models are presented. Results: At median 2.3 [IQR 1.0, 3.7] & 2.7 [1.8, 4.0] years post-TX, 1 & 3 year survival were [K] 95% (CI 90%, 98%) & 91% (84%, 95%) & [L] 80% (72%, 86%) & 67% (56%, 75%). K mortality associated with HCV (HR 3.17; CI 1.10, 9.09; p=0.03), age (HR 1.06; 1.01, 1.11; p=0.03) & initial thymo (marginal: HR 2.63; 0.94, 7.31; p=0.06). For L, dual L/K TX (HR 4.86; 1.93, 12.2; p=0.0008), pre-TX BMI <21 (HR 2.74; 1.25, 5.98; p=0.01), donor age>40 (HR 2.23; 1.07, 4.64; p=0.03), HCV (marginal: HR 2.47; 0.95, 6.44; p=0.06) & detectable enroll VL (marginal: HR 2.07; 0.89, 4.81; p=0.09) were significant. Significant survival benefit for MELD≥15 L (HR: 0.09; 0.05, 0.16; p<0.0001), but not for low MELD (HR 0.71; 0.27, 1.85; p=0.48) or K (HR 0.67; 0.31, 1.45; p=0.31). 52 (19%) had 90 prior OIs: 30 PCP, 8 CMV, 7 MAC & 3 KS. 13 post-TX OIs: 4 KS, 6 Candida, 2 PCP & 1 cryptosporidiosis. No recurrences or survival differences in those with OI history. 77 (51%) K & 70 (56%) L reported 212 & 243 SI. Factors associated with SI in K: HCV (HR 2.27; 1.33, 3.87; p=0.003), initial thymo (HR 2.10; 1.25, 3.53; p=0.01) & nadir CD4 (HR 0.93; 0.87, 1.00; p=0.048). For L, HCV (HR 2.34; 1.13, 4.83; p=0.02), CD4 as TDC (HR 0.88; 0.80, 0.98; p=0.02) & white race (HR 0.49; 0.28, 0.85; p=0.01) were significant. Conclusions: K survival is excellent & L TX in high MELD confers survival benefit. HIV factors are not associated with mortality/OI. CD4 is the only HIV factor associated with SI. BL factors may influence selection criteria.