Control of HIV replication by means of HAART has allowed for HIV positive patients to be reconsidered as transplant candidates. Objectives of this study are to describe the clinical characteristics and evolution of an HIV+ patient population, who received a liver transplantation (LT) in our center and to analize complications and mortality rate.
This is a single center, retrospective cohort study, of LT performed in our center on HIV+ receptors. Survival was estimated with the Kaplan Meier method and was expressed as accumulated survival with confidence intervals of 95%
From July 2006 until December 2015 there were 14 LT performed in 13 p. Age: 45y median (r:37-56). Gender: M/F 12/2. Seven p. stopped HAART due to toxicity before transplant. CD4 at admission to the waiting list: 283/mm3.Viral load (VL): 24.716 copies/ml (r: indetectable-152113). Liver disease: 12 p. HCV, 3 associated to hepatocarcinoma (HCC) and one HBV + HCC.Time from admission to the waiting list until transplant: 6.5 months median (r: 0-26). MELD at admission to the list: Average of 26 (r: 20-36). Nine patients had acute rejection (1 steroid-resistant). There was no graft loss due to rejection as sole cause, one p. required re-LT due to relapse of HCV plus biliar disease plus rejection. Relapse of HCV 100%. Time from LT to relapse: 6 months (r: 1-28), 5 of them were severe. Eight received treatment: 6 achieved sustained virologic response , one partial response , and one failure. None showed complications related to HIV. Nine p. switched HAART post Tx In post-LT, all p. exhibited VL of HIV undetectable. Average CD4 6 months post-LT: 303 and 12 months: 354 (r: 123-1098).Three p. died: 2 due to HCV relapse, both with multiple organ failure, and another p. due to HCC relapse associated to HBV.
LT is possible in our population, giving priority to an adequate selection of candidates for the waiting list and multi-disciplinary followup during post LT. Immunosuppression added by the LT had no repercussions in the control of HIV infection. Despite the almost universal HCV relapse, even severe forms can be controlled with the currently available drugs. Mortality rate was lower in our series compared with published reports.
A. Valledor, None
A. Smud, None
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