Outcomes of Orthotopic Liver Transplant Patients With Human-Immunodeficiency-Virus (HIV) Infection at Miami University.

Abstract

Background: Patients with human immunodeficiency virus (HIV) often have a hepatitis C virus (HCV) or hepatitis B (HBV) virus co-infection, or both, as a cause of their liver diseases. The introduction of highly active antiretroviral therapy (HAART) has enabled the control of HIV infection in most patients and resulted in a marked decrease in opportunistic infections and an increase in life expectancy. Therefore, HIV positive patients experiencing complications of liver failure are at greater immediate risk of dying from their end-stage liver disease rather than HIV. To improve the outcomes of liver transplant for HIV positive patients, we analyzed the data about liver transplant patients with HIV infection at our institution. Materials/ Methods: A retrospective analysis of all HIV patients who underwent OLT at Miami University was performed. Twenty-nine HIV infected patients underwent OLT between January 1998 and September 2012. Results: The median age was 44 years-old (36-65 years-old). Fourteen had HCV co-infections and 12 had HBV co-infections. Two patients suffered from hepatocellular carcinoma and 2 patients underwent combined liver and kidney transplant. The actuarial 6-month, 1- and 5- year survival rates after transplantation were 72.4%, 72.4% and 64.6% respectively. Seven patients (24%) died due to infection, which is significantly higher rate of cause of death in organ transplant patients without HIV infection. Conclusions: The long-term outcomes of liver transplants for HIV positive patients are evolving and becoming more successful. However the mortality rate in the early post transplant period remains high especially when the cause of death is infection. To promote survival rates in the early post transplant period of HIV positive patients, being able to control infection will be the key to success.