Abstract
Simple SummaryHCC are now emerging as leading causes of morbidity in HIV-infected patients since HAART has made it possible to achieve long life expectation by reducing AIDS-related complications. The results of liver transplantation for HCC in HIV-infected patients are still contradictory. In this paper we demonstrated in a cohort of 32 HIV-infected patients undergoing LT for HCC that the post-LT outcomes are comparable to the controlled cohort of uninfected recipients. Long survival rates were observed for HIV-infected LT patients with HCC.Background: HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV-infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. Results: Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (p = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (p = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83, p = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18, p< 0.001), HCC diameter (HR 1.16, p = 0.028), and number of HCC nodules (HR 1.26, p = 0.003) were predictors of recurrence post-LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.
Highlights
The introduction of highly active antiretroviral therapy (HAART) has revolutionized the long-term survival expectations of HIV patient [1]
50.3 ± 5.6 years compared to patients in the HIV-uninfected group 57.6 ± 8.1, p = 0.001
While the rate of HBV infection did not differ between the two groups (23.5% vs. 25.1%), the HCV infection was most frequently observed in the HIV+ group (70.5% vs. 54.1%)
Summary
The introduction of highly active antiretroviral therapy (HAART) has revolutionized the long-term survival expectations of HIV patient [1]. For this reason, long-term morbidity currently appears to be linked to the onset of chronic diseases, while the risk of mortality from opportunistic diseases and AIDS-related events is dramatically reduced [2]. End stage liver disease (ESLD) and HCC are currently the most frequent causes of death in the HIV-infected population, with an annual risk of liver-related death mortality of 50% [5]. HIV-infected patients have long life expectation since the introduction of the highly active antiretroviral therapy (HAART).
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