Ragni Margaret V, Eghtesad Bijan, Schlesinger Kimberly W, Dvorchik Igor, Fung John J
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-4306, USA.
Liver Transpl. 2005 Nov;11(11):1425-30. doi: 10.1002/lt.20534.
Despite improved survival after liver transplantation (OLTX) in HIV-positive individuals treated with highly active antiretroviral therapy (HAART), some transplant candidates do not survive to OLTX. To determine if pretransplant outcome is related to severity of liver disease and/or HIV infection, we prospectively evaluated 58 consecutive HIV-positive candidates seen at a single center from 1997-2002. Of the 58, 15 (25.9%) were transplanted, whereas 21 (36.2%) died before OLTX, a median one month of evaluation, with more than half of those (12 of 21, 57.1%) dying from infection. By contrast, of 1,359 HIV-negative candidates, 860 (63.3%) were transplanted, whereas 211 (15.5%) died before OLTX (P < 0.001). The cumulative survival following initial evaluation was significantly shorter among HIV-positive than HIV-negative candidates (880 vs. 1,427 days, P = 0.035, Breslow) but was not related to the initial pretransplant MELD score (16 vs. 15), INR (1.5 vs. 1.5), creatinine (1.3 vs. 1.3 mg/dL), or total bilirubin (6.6 vs. 5.7 mg/dL), respectively, all P > 0.05. Among untransplanted HIV-positive candidates, the 21 who died did not differ from the 22 surviving in initial MELD (15 vs. 13), CD4 (230 vs. 327/microL), HIV load (both < 400 copies/mL), HAART intolerance (10/21, 47.6% vs. 10/22, 45.4%), or HCV infection (16/21, 76.2% vs. 16/22, 72.3%), all P > 0.05. Further, the 21 did not differ from the 15 transplanted in pre-OLTX CD4, HIV load, or MELD score, all P > 0.05. In conclusion, pretransplant survival appears shorter in HIV-positive OLTX candidates and is unrelated to severity of liver or HIV disease. Further study is warranted to determine risk factors for poorer pretransplant outcomes.
尽管接受高效抗逆转录病毒疗法（HAART）治疗的HIV阳性个体肝移植（OLTX）后的生存率有所提高，但一些移植候选人未能存活至接受OLTX。为了确定移植前的预后是否与肝脏疾病和/或HIV感染的严重程度相关，我们前瞻性评估了1997年至2002年在单一中心连续就诊的58例HIV阳性候选人。在这58例中，15例（25.9%）接受了移植，而21例（36.2%）在OLTX前死亡，评估的中位时间为1个月，其中超过一半（21例中的12例，57.1%）死于感染。相比之下，在1359例HIV阴性候选人中，860例（63.3%）接受了移植，而211例（15.5%）在OLTX前死亡（P < 0.001）。初始评估后的累积生存率在HIV阳性候选人中显著短于HIV阴性候选人（880天对1427天，P = 0.035，Breslow检验），但与移植前初始的终末期肝病模型（MELD）评分（16对15）、国际标准化比值（INR）（1.5对1.5）、肌酐（1.3对1.3mg/dL）或总胆红素（6.6对5.7mg/dL）均无关，所有P值均> 0.05。在未接受移植的HIV阳性候选人中，死亡的21例与存活的22例在初始MELD评分（15对13）、CD4细胞计数（230对327/μL）、HIV病毒载量（均< 400拷贝/mL）、对HAART不耐受情况（21例中的10例，47.6%对22例中的10例，45.4%）或丙型肝炎病毒（HCV）感染情况（21例中的16例，76.2%对22例中的16例，72.3%）方面均无差异，所有P值均> 0.05。此外，这21例在移植前的CD4细胞计数、HIV病毒载量或MELD评分方面与接受移植的15例也无差异，所有P值均> 0.05。总之，HIV阳性的OLTX候选人移植前的生存率似乎较短，且与肝脏或HIV疾病的严重程度无关。有必要进一步研究以确定移植前预后较差的危险因素。
