- Category: Liver & Kidney Disease
- Published on Monday, 18 July 2011 00:00
- Written by Paul Dalton
Kidney and Liver transplants can be safe and effective for people living with HIV. However hepatitis C virus (HCV) coinfection and several other factors may make such procedures more risky.
Organ diseases, including those of the liver and kidneys, are major causes of death among people with HIV. Until fairly recently, people living with HIV in the U.S. were considered ineligible for solid organ transplants due to fears about infection and the need to use immunosuppressive drugs to avoid rejection.
However, since the Cleveland Clinic began considering transplantations for people with HIV in 2000, this life-saving option has become more accessible to HIV positive people.
To better understand the experiences and risks of solid organ transplants in people living with HIV, George Beatty from the University of California San Francisco and his collaborators looked at medical records regarding 125 liver and 150 kidney transplants in people living with HIV.
The researchers assessed patient survival, risk of AIDS-defining opportunistic infections (OIs), and other serious infections causing hospitalization. Beatty presented promising results from this analysis in an oral presentation at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) taking place this week in Rome.
- After 1 year 95% of kidney transplant recipients were alive; after 3 years 91% were.
- After 1 year 80% of liver transplant recipients were alive; after 3 years 67% were.
- Predictors of mortality included:
o For kidney transplant recipients: HCV coinfection (hazard ratio [HR] 3.17), older age (HR 1.06 per 10 years), and initial use of thymoglobulin (HR 2.63).
o For liver transplant recipients: dual liver/kidney transplant (HR 4.56), pre-transplant body mass index (BMI) < 21 (HR 2.74), donor age > 40 (HR 2.23), HCV coinfection (HR 2.47), and detectable HIV viral load at enrollment (HR 2.07).
- Predictors of non-OI serious infections included:
o For kidney transplant recipients: HCV coinfection (HR 2.27), initial use of thymoglobulin (HR 2.1), and nadir or lowest-ever CD4 T-cell count (HR 0.93 per +100 cells).
o For liver transplant recipients: HCV coinfection (HR 2.34), CD4 cell count (HR 0.88 per +100 cells), and Caucasian race (HR 0.49).
o History of opportunistic infections did not predict mortality.
The researchers concluded, based on these results, that “HIV disease should not be considered a contraindication for kidney or liver transplants.” They stressed, however, that various factors such as HCV coinfection should be weighed in the decision.
As people with HIV -- and with HIV and hepatitis B or C coinfection -- ages, the need for solid organ transplants is likely to grow. This research should help establish that such potentially life-saving procedures can be done safely and effectively in people living with HIV.
G Beatty, B Barin, L Fox, et al. HIV-related predictors and outcomes in 275 liver and/or kidney transplant recipients. 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011). Rome. July 17-20, 2011.