Liver Retransplantation in Patients With HIV-1 Infection: An International Multicenter Cohort Study

Area of Science:

• Hepatology
• Infectious Diseases
• Transplantation Immunology

Background:

• Liver retransplantation in human immunodeficiency virus (HIV)-infected patients is uncommon.
• Outcomes and prognostic factors for liver retransplantation in this population are not well-established.
• Coinfection with hepatitis C virus (HCV) or hepatitis B virus (HBV) is common in HIV-infected patients undergoing liver transplantation.

Purpose of the Study:

• To evaluate the outcomes of liver retransplantation in HIV-infected patients.
• To identify prognostic factors influencing survival after liver retransplantation in this cohort.
• To assess the impact of viral coinfection (HCV and HBV) on retransplantation success.

Main Methods:

• International cohort study involving 600 HIV-infected patients who underwent liver transplantation.
• Analysis of 37 patients (6%) who subsequently required liver retransplantation.
• Retrospective review of indications for retransplantation, patient survival, and prognostic factors, including viral load.

Main Results:

• Vascular complications, primary graft nonfunction, rejection, and HCV recurrence were primary indications for retransplantation.
• Overall 1-year, 3-year, and 5-year survival rates were 56%, 51%, and 51%, respectively.
• For HCV coinfected patients, undetectable HCV RNA at retransplantation correlated with significantly better survival (80% at 1 year) compared to detectable HCV RNA (39% at 1 year).

Conclusions:

• Liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection if HCV RNA is undetectable.
• Hepatitis C recurrence is a major cause of mortality in HCV coinfected patients with detectable viral load.
• Further prospective studies are needed to evaluate retransplantation in HCV-replicating patients, especially with new direct antiviral agents.