Liver transplant outcomes in HIV(+) haemophilic men. (5th July 2012)

• Record Type: Journal Article
• Authors: Ragni, M. V.; DeVera, M. E.; Roland, M. E.; Wong, M.; Stosor, V.; Sherman, K. E.; Hardy, D.; Blumberg, E.; Fung, J.; Barin, B.; Stablein, D.; Stock, P. G.
• Is Part Of: Haemophilia. Volume 19:Number 1(2013:Jan.)
• Page Start: 134
• Page End: 140
• Publication Date: 2012-07-05
• Subjects: Hemophilia -- Periodicals; 616.1572005
• DOI: 10.1111/j.1365-2516.2012.02905.x
• Languages: English
• ISSNs: 1351-8216

Abstract

<abstract abstract-type="main" id="hae2905-abs-0001"> <title>Summary</title> <p>Hepatitis C virus infection is the major cause of end‐stage liver disease and the major indication for transplantation (OLTX), including among HIV‐HCV co‐infected individuals. The age of HCV acquisition differs between haemophilic and non‐haemophilic candidates, which may affect liver disease outcomes. The purpose of the study was to compare rates of pre‐ and post‐OLTX mortality between co‐infected haemophilic and non‐haemophilic subjects without hepatocellular cancer participating in the Solid Organ Transplantation in HIV Study (HIV‐TR). Clinical variables included age, gender, race, liver disease aetiology, BMI, antiretroviral therapy, MELD score, CD4 + cell count, HIV RNA PCR and HCV RNA PCR. Time to transplant, rejection and death were determined. Of 104 HIV‐HCV positive subjects enrolled, 34 (32.7%) underwent liver transplantation, including 7 of 15 (46.7%) haemophilic and 27 of 89 (30.3%) non‐haemophilic candidates. Although haemophilic subjects were younger, median 41 vs. 47 years, <italic>P</italic> = 0.01, they were more likely than non‐haemophilic subjects to die pre‐OLTX, 5 (33.3%) vs. 13 (14.6%), <italic>P</italic> = 0.03, and reached MELD = 25 marginally faster, 0.01 vs. 0.7 years, <italic>P</italic> = 0.06. The groups did not differ in baseline BMI, CD4, detectable HIV RNA, detectable HCV RNA, time to post‐OLTX death (<italic>P</italic> = 0.64), graft loss (<italic>P</italic> = 0.80), or treated rejection (<italic>P</italic> = 0.77). The rate of rejection was 14% vs. 36% at 1‐year and 36% vs. 43% at 3‐year, haemophilic vs. non‐haemophilic subjects, respectively, and post‐OLTX survival, 71% vs. 66% at 1‐year and 38% vs. 53% at 3‐year. Despite similar transplant outcomes, pretransplant mortality is higher among co‐infected haemophilic than non‐haemophilic candidates.</p> </abstract>