HIV-Related Predictors and Outcomes in 275 Liver and/or Kidney Transplant Recipients (oral presentation)
Year of Publication
Beatty, G; Barin, B; Fox, L; Odim, J; Huprikar, S; Wong, M; Diego, J; Blumberg, E; Simon, D; Light, J; Yin, M; Davis, C; Jayaweera, D; Hardy, D; Ragni, M; Johnson, L; Subramanian, A; Stosor, T; Brayman, K; Pursell, K; Zang, R; Lyon, G; Taege, A; Feinberg, J; Weikert, B; Stock, P; Roland, M
International AIDS Society
Background: Although end-organ disease is a major cause of morbidity and mortality in HIV-disease, concerns about survival and infection risk have led to hesitation to transplant HIV+ recipients. Kidney transplants (TX) were performed in 150 patients with CD4>200 and undetectable viral load (VL) and liver TX in 125 patients with CD4>100 and achieved or predicted control of VL.Methods: Age, sex, race, enrollment/pre-TX/current CD4, HIV-VL, MELD (for L), BMI, thymoglobulin use (THY), HCV, opportunistic infection (OI), dual L/K TX, and donor characteristics were assessed as predictors of survival and of first non-OI serious infection (NSI), by multivariate proportional hazards models. We describe prior/post-TX OI. Results: TX was associated with significant survival benefit for liver with MELD≥15 (HR: 0.09; 0.05, 0.16; p< 0.0001), but not for MELD< 15 (HR 0.71; 0.27, 1.85; p=0.48) or for kidney (HR 0.67; 0.31, 1.45; p=0.31). 52 (19%) had prior OIs (PCP, CMV, MAC, KS), but OI history was not associated with recurrence or survival differences. 13 post-TX OIs were reported (4 KS, 6 Candida, 2 PCP & 1 cryptosporidiosis). NSI occurred in 77 (51%) K & 70 (56%) L. Conclusion: Excellent results following kidney transplantation and survival benefit in liver transplantation with MELD≥15 indicate that HIV-disease should not be considered a contraindication to transplantation. Although CD4 is associated with NSI, HIV factors do not affect mortality/OI. Selection criteria should include baseline factors contributing to outcome.