Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.
Transplantation. 2020 Oct;104(10):2078-2086. doi: 10.1097/TP.0000000000003107.
We evaluated trends and outcomes of liver transplantation (LT) recipients with/without HIV infection.
LT recipients between 2008 and 2015 from the United Network for Organ Sharing and Organ Procurement and Transplantation Network and European Liver Transplant Registry were included. Trends and characteristics related to survival among LT recipients with HIV infection were determined.
Among 73 206 LT patients, 658 (0.9%) were HIV-infected. The proportion of LT HIV-infected did not change over time (P-trend = 0.16). Hepatitis C virus (HCV) as indication for LT decreased significantly for HIV-infected and HIV-uninfected patients (P-trends = 0.008 and <0.001). Three-year cumulative graft survival in LT recipients with and without HIV infection was 64.4% and 77.3%, respectively (P < 0.001), with improvements over time for both, but with HIV-infected patients having greater improvements (P-trends = 0.02 and 0.03). Adjusted risk of graft loss was 41% higher in HIV-infected versus HIV-uninfected (adjusted hazard ratio [aHR], 1.41; P < 0.001). Among HIV-infected, model of end-stage liver disease (aHR, 1.04; P < 0.001), body mass index <21 kg/m (aHR, 1.61; P = 0.006), and HCV (aHR, 1.83; P < 0.001) were associated with graft loss, whereas more recent period of LT 2012-2015 (aHR, 0.58; P = 0.001) and donor with anoxic cause of death (aHR, 0.51; P = 0.007) were associated with lower risk of graft loss.
Patients with HIV infection account for only 1% of LTs in United States and Europe, with fewer LT for HCV disease over time. A static rate of LT among HIV-infected patients may reflect improvements in cirrhosis management and/or persistent barriers to LT. Graft and patient survival among HIV-infected LT recipients have shown improvement over time.
我们评估了有/无 HIV 感染的肝移植（LT）受者的趋势和结局。
纳入了 2008 年至 2015 年期间来自美国器官共享联合网络和器官获取与移植网络以及欧洲肝移植登记处的 LT 受者。确定了 HIV 感染的 LT 受者中与生存相关的趋势和特征。
在 73206 例 LT 患者中，有 658 例（0.9%）感染了 HIV。HIV 感染的 LT 比例并未随时间变化（P 趋势=0.16）。HCV 作为 LT 的指征，在 HIV 感染和未感染的患者中均显著下降（P 趋势=0.008 和 <0.001）。有和无 HIV 感染的 LT 受者的 3 年累积移植物存活率分别为 64.4%和 77.3%（P<0.001），两者均随时间改善，但 HIV 感染患者的改善幅度更大（P 趋势=0.02 和 0.03）。与无 HIV 感染的患者相比，HIV 感染的患者发生移植物丢失的风险高 41%（调整后的危险比[HR]，1.41；P<0.001）。在 HIV 感染患者中，终末期肝病模型（HR，1.04；P<0.001）、体重指数<21kg/m（HR，1.61；P=0.006）和 HCV（HR，1.83；P<0.001）与移植物丢失相关，而 LT 时间较近（2012-2015 年）（HR，0.58；P=0.001）和供体因缺氧性死亡（HR，0.51；P=0.007）与移植物丢失风险降低相关。
在美国和欧洲，HIV 感染患者仅占 LT 的 1%，随着时间的推移，HCV 疾病的 LT 数量减少。HIV 感染患者的 LT 率保持不变可能反映了肝硬化管理的改善和/或 LT 持续存在的障碍。HIV 感染的 LT 受者的移植物和患者生存率随时间有所改善。
