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Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C.
Am J Transplant 2006; 6(12):2983-93AJ

Abstract

Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled post-transplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95% CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score > 20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA > 30000000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-alpha/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.

Authors+Show Affiliations

Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. deverame@upmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17062005

Citation

de Vera, M E., et al. "Survival of Liver Transplant Patients Coinfected With HIV and HCV Is Adversely Impacted By Recurrent Hepatitis C." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 6, no. 12, 2006, pp. 2983-93.
de Vera ME, Dvorchik I, Tom K, et al. Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. Am J Transplant. 2006;6(12):2983-93.
de Vera, M. E., Dvorchik, I., Tom, K., Eghtesad, B., Thai, N., Shakil, O., ... Ragni, M. V. (2006). Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 6(12), pp. 2983-93.
de Vera ME, et al. Survival of Liver Transplant Patients Coinfected With HIV and HCV Is Adversely Impacted By Recurrent Hepatitis C. Am J Transplant. 2006;6(12):2983-93. PubMed PMID: 17062005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C. AU - de Vera,M E, AU - Dvorchik,I, AU - Tom,K, AU - Eghtesad,B, AU - Thai,N, AU - Shakil,O, AU - Marcos,A, AU - Demetris,A, AU - Jain,A, AU - Fung,J J, AU - Ragni,M V, PY - 2006/10/26/pubmed PY - 2007/3/7/medline PY - 2006/10/26/entrez SP - 2983 EP - 93 JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am. J. Transplant. VL - 6 IS - 12 N2 - Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled post-transplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95% CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score > 20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA > 30000000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-alpha/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx. SN - 1600-6135 UR - https://www.unboundmedicine.com/medline/citation/17062005/Survival_of_liver_transplant_patients_coinfected_with_HIV_and_HCV_is_adversely_impacted_by_recurrent_hepatitis_C_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-6135&date=2006&volume=6&issue=12&spage=2983 DB - PRIME DP - Unbound Medicine ER -