Centre Hepato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
Hepatology. 2011 Feb;53(2):475-82. doi: 10.1002/hep.24062. Epub 2011 Jan 3.
Liver transplantation (LT) has become an accepted therapy for end-stage liver disease in human immunodeficiency virus-positive (HIV+) patients, but the specific results of LT for hepatocellular carcinoma (HCC) are unknown. Between 2003 and 2008, 21 HIV+ patients and 65 HIV- patients with HCC were listed for LT at a single institution. Patient characteristics and pathological features were analyzed. Univariate analysis for overall survival (OS) and recurrence-free survival (RFS) after LT was applied to identify the impact of HIV infection. HIV+ patients were younger than HIV- patients [median age: 48 (range = 41-63 years) versus 57 years (range = 37-72 years), P < 0.001] and had a higher alpha-fetoprotein (AFP) level [median AFP level: 16 (range = 3-7154 μg/L] versus 13 μg/L (range = 1-552 μg/L), P = 0.04]. There was a trend toward a higher dropout rate among HIV+ patients (5/21, 23%) versus HIV- patients (7/65, 10%, P = 0.08). Sixteen HIV+ patients and 58 HIV- patients underwent transplantation after median waiting times of 3.5 (range = 0.5-26 months) and 2.0 months (range = 0.5-24 months, P = 0.18), respectively. No significant difference was observed in the pathological features of HCC. With median follow-up times of 27 (range = 5-74 months) and 36 months (range = 3-82 months, P = 0.40), OS after LT at 1 and 3 years reached 81% and 74% in HIV+ patients and 93% and 85% in HIV- patients, respectively (P = 0.08). RFS rates at 1 and 3 years were 69% and 69% in HIV+ patients and 89% and 84% in HIV- patients, respectively (P = 0.09). In univariate analysis, HIV status did not emerge as a prognostic factor for OS or RFS.
Because of a higher dropout rate among HIV+ patients, HIV infection impaired the results of LT for HCC on an intent-to-treat basis but had no significant impact on OS and RFS after LT.
肝移植（LT）已成为人类免疫缺陷病毒阳性（HIV+）患者终末期肝病的一种公认治疗方法，但 HIV+患者接受 LT 治疗肝细胞癌（HCC）的具体结果尚不清楚。
在一个机构中，2003 年至 2008 年期间，21 例 HIV+患者和 65 例 HIV-患者因 HCC 接受 LT 治疗。分析患者特征和病理特征。应用单因素分析 LT 后总生存（OS）和无复发生存（RFS），以确定 HIV 感染的影响。
HIV+患者比 HIV-患者年轻[中位年龄：48（范围=41-63 岁）比 57 岁（范围=37-72 岁），P<0.001]，甲胎蛋白（AFP）水平更高[中位 AFP 水平：16（范围=3-7154μg/L]比 13μg/L（范围=1-552μg/L），P=0.04]。HIV+患者的脱落率较高（5/21，23%），高于 HIV-患者（7/65，10%，P=0.08）。16 例 HIV+患者和 58 例 HIV-患者在中位等待时间分别为 3.5（范围=0.5-26 个月）和 2.0 个月（范围=0.5-24 个月，P=0.18）后接受移植。两组 HCC 的病理特征无显著差异。HIV+患者的中位随访时间为 27（范围=5-74 个月），HIV-患者为 36 个月（范围=3-82 个月，P=0.40）。LT 后 1 年和 3 年的 OS 分别为 HIV+患者的 81%和 74%，HIV-患者的 93%和 85%（P=0.08）。HIV+患者和 HIV-患者的 RFS 率在 1 年和 3 年时分别为 69%和 69%，分别为 89%和 84%（P=0.09）。在单因素分析中，HIV 状态不是 OS 或 RFS 的预后因素。
由于 HIV+患者的脱落率较高，HIV 感染在治疗意向基础上对 HCC 的 LT 结果产生了不利影响，但对 LT 后的 OS 和 RFS 没有显著影响。
