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Outcome of HCV/HIV-coinfected liver transplant recipients: a prospective and multicenter cohort study

J M Miro1, M Montejo, L Castells

  • 1Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain. jmmiro@ub.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|April 5, 2012
PubMed

Insights

Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) coinfection impacts liver transplant survival. A subset of coinfected patients shows a favorable prognosis, indicating personalized risk assessment is crucial for these liver transplant recipients.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Transplantation Medicine

Background:

  • Liver transplantation is a critical treatment for end-stage liver disease.
  • Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) coinfection presents unique challenges in liver transplant recipients.
  • Understanding survival outcomes in coinfected patients is essential for improving post-transplant care.

Purpose of the Study:

  • To compare 5-year survival rates between HCV/HIV-coinfected and HCV-monoinfected liver transplant recipients.
  • To identify predictors of mortality in HCV/HIV-coinfected liver transplant recipients.
  • To determine if a subset of coinfected patients with a favorable prognosis can be identified.

Main Methods:

  • Prospective, multicenter study involving 84 HCV/HIV-coinfected and 252 matched HCV-monoinfected liver transplant recipients.
  • Survival analysis and multivariate regression were used to identify mortality predictors.
  • Analysis was stratified to include pretransplant variables for risk stratification.

Main Results:

  • Five-year survival was significantly lower in HCV/HIV-coinfected recipients (54%) compared to HCV-monoinfected recipients (71%).
  • HIV infection was an independent predictor of mortality post-liver transplant.
  • HCV genotype 1, high donor risk index, and negative plasma HCV RNA were associated with mortality in coinfected patients. Pretransplant MELD score and transplant center volume also influenced outcomes.

Conclusions:

  • HCV/HIV coinfection is associated with reduced 5-year survival after liver transplantation.
  • Despite lower overall survival, a subset of HCV/HIV-coinfected liver transplant recipients with favorable pretransplant factors demonstrated comparable outcomes to HCV-monoinfected recipients.
  • Personalized risk assessment and management strategies are vital for optimizing outcomes in coinfected liver transplant patients.

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