Liver transplant outcomes in HIV(+) haemophilic men

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 19; no. 1; pp. 134 - 140
• Main 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.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.01.2013
• Subjects: Adult; Age; antiretroviral therapy; Cancer; CD4 antigen; Coinfection - mortality; Graft rejection; haemophilia; Hemophilia; Hemophilia A - mortality; hepatitis C liver disease; Hepatitis C virus; Hepatitis C, Chronic - mortality; Hepatitis C, Chronic - surgery; HIV Infections - mortality; HIV-HCV co-infection; Human immunodeficiency virus; Humans; Infection; Liver diseases; Liver Failure - etiology; Liver Failure - mortality; Liver Failure - surgery; Liver transplantation; Liver Transplantation - mortality; Male; Middle Aged; Mortality; Polymerase chain reaction; Proportional Hazards Models; Races; RNA; Survival
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/j.1365-2516.2012.02905.x

Summary 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, P = 0.01, they were more likely than non‐haemophilic subjects to die pre‐OLTX, 5 (33.3%) vs. 13 (14.6%), P = 0.03, and reached MELD = 25 marginally faster, 0.01 vs. 0.7 years, P = 0.06. The groups did not differ in baseline BMI, CD4, detectable HIV RNA, detectable HCV RNA, time to post‐OLTX death (P = 0.64), graft loss (P = 0.80), or treated rejection (P = 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.