HIV-infected liver and kidney transplant recipients: 1- and 3-year outcomes

Am J Transplant. 2008 Feb;8(2):355-65. doi: 10.1111/j.1600-6143.2007.02061.x. Epub 2007 Dec 18.

Abstract

Improvements in human immunodeficiency virus (HIV)-associated mortality make it difficult to deny transplantation based upon futility. Outcomes in the current management era are unknown. This is a prospective series of liver or kidney transplant recipients with stable HIV disease. Eleven liver and 18 kidney transplant recipients were followed for a median of 3.4 years (IQR [interquartile range] 2.9-4.9). One- and 3-year liver recipients' survival was 91% and 64%, respectively; kidney recipients' survival was 94%. One- and 3-year liver graft survival was 82% and 64%, respectively; kidney graft survival was 83%. Kidney patient and graft survival were similar to the general transplant population, while liver survival was similar to the older population, based on 1999-2004 transplants in the national database. CD4+ T-cell counts and HIV RNA levels were stable; and there were two opportunistic infections (OI). The 1- and 3-year cumulative incidence (95% confidence intervals [CI]) of rejection episodes for kidney recipients was 52% (28-75%) and 70% (48-92%), respectively. Two-thirds of hepatitis C virus (HCV)-infected patients, but no patient with hepatitis B virus (HBV) infection, recurred. Good transplant and HIV-related outcomes among kidney transplant recipients, and reasonable outcomes among liver recipients suggest that transplantation is an option for selected HIV-infected patients cared for at centers with adequate expertise.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Cadaver
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • Humans
  • Kidney Transplantation / immunology
  • Kidney Transplantation / statistics & numerical data*
  • Liver Transplantation / immunology
  • Liver Transplantation / statistics & numerical data*
  • Living Donors
  • Male
  • Middle Aged
  • Time Factors
  • Tissue Donors / statistics & numerical data
  • Treatment Outcome
  • Viral Load