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Liver transplant outcomes in HIV+ haemophilic men

M V Ragni1, M E Devera, M E Roland

  • 1Department of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA 15213-4306, USA.

Haemophilia : the Official Journal of the World Federation of Hemophilia
|July 6, 2012
PubMed

Insights

HIV-HCV co-infected individuals undergoing liver transplantation (OLTX) show higher pre-OLTX mortality in hemophilic candidates despite similar post-transplant outcomes. Hemophilic subjects experienced higher pre-transplant death rates compared to non-hemophilic counterparts.

Area of Science:

  • Hepatology
  • Virology
  • Transplantation Immunology

Background:

  • Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease and liver transplantation (OLTX).
  • HIV-HCV co-infection presents unique challenges in liver disease progression and transplantation outcomes.
  • Age of HCV acquisition may influence liver disease severity and outcomes in hemophilic versus non-hemophilic patients.

Purpose of the Study:

  • To compare pre- and post-OLTX mortality rates between HIV-HCV co-infected hemophilic and non-hemophilic subjects without hepatocellular cancer.
  • To analyze clinical variables influencing outcomes in this co-infected population undergoing OLTX.

Main Methods:

  • Retrospective analysis of 104 HIV-HCV co-infected subjects from the Solid Organ Transplantation in HIV Study (HIV-TR).
  • Comparison of clinical variables including age, MELD score, CD4 count, viral load, and time to transplant, rejection, and death.
  • Stratification of subjects into hemophilic and non-hemophilic groups.

Main Results:

  • Hemophilic subjects (n=7) were younger (median 41 vs. 47 years) but had higher pre-OLTX mortality (33.3% vs. 14.6%) and reached MELD=25 faster.
  • No significant differences were observed in baseline BMI, CD4, HIV/HCV RNA, post-OLTX death, graft loss, or treated rejection between groups.
  • 1-year rejection rates were 14% (hemophilic) vs. 36% (non-hemophilic); 3-year survival was 38% (hemophilic) vs. 53% (non-hemophilic).

Conclusions:

  • Despite similar post-transplant outcomes, HIV-HCV co-infected hemophilic candidates face a higher risk of pre-transplant mortality.
  • Younger age at HCV acquisition in hemophilic individuals may contribute to accelerated liver disease progression.
  • Further research is needed to optimize pre-transplant management and improve outcomes for hemophilic patients awaiting liver transplantation.

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