Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
Am J Transplant. 2021 Sep;21(9):3148-3156. doi: 10.1111/ajt.16569. Epub 2021 Jul 8.
We evaluated whether indications for liver transplantation (LT) have changed among people with/without human immunodeficiency virus (HIV) infection and compared LT outcomes and trends by HIV serostatus. LT recipients (2008-2018) from the United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) were identifed. Among 62 195 LT recipients, 352 (0.6%) were HIV-infected. The proportion of HIV-infected patients increased over time (P trend = .001), as did the number of transplant centers performing LT for HIV-infected recipients; average annual percentage change of 9.2% (p < .001). Nonviral causes became the leading indication in 2015 for HIV-uninfected and in 2018 for HIV-infected (P trend < .001). Three-year cumulative patient survival rates were 77.5%, for HIV-infected and 84.6%, for HIV-uninfected (p = .15). Over time, graft and patient survival rates improved for both HIV-infected and uninfected (p < .001). Among HCV-infected LT recipients, 3-year patient survival rates were 72.5% for HIV-infected and 81.8% for HIV-uninfected (p = .02). However, in a subanalysis restricted to 2014-2018, differences in graft and patient survival by HIV serostatus were no longer observed (3-year patient survival rates were 81.2% for HIV-infected and 86.4% for HIV-uninfected, p = .34). In conclusion, in the United States, nonviral liver disease is now the leading indication for LT in HIV-infected patients, and posttransplant outcomes have improved over time.
我们评估了在感染人类免疫缺陷病毒（HIV）和未感染 HIV 的人群中，肝移植（LT）的适应证是否发生了变化，并比较了 HIV 血清学状态对 LT 结局和趋势的影响。从美国器官共享联合网络（UNOS）和器官获取和移植网络（OPTN）中确定了 2008 年至 2018 年间接受 LT 的患者。在 62195 例 LT 受者中，有 352 例（0.6%）感染了 HIV。感染 HIV 的患者比例随时间推移而增加（趋势 P 值=0.001），进行 HIV 感染患者 LT 的移植中心数量也随之增加；平均每年百分比变化为 9.2%（P 值<0.001）。2015 年，非病毒性病因成为 HIV 未感染者的主要适应证，2018 年成为 HIV 感染者的主要适应证（趋势 P 值<0.001）。3 年累积患者生存率分别为 HIV 感染者的 77.5%和 HIV 未感染者的 84.6%（P 值=0.15）。随着时间的推移，HIV 感染者和未感染者的移植物和患者生存率都有所提高（P 值<0.001）。在 HCV 感染的 LT 受者中，3 年患者生存率分别为 HIV 感染者的 72.5%和 HIV 未感染者的 81.8%（P 值=0.02）。然而，在仅限于 2014-2018 年的亚分析中，HIV 血清学状态对移植物和患者生存率的差异不再存在（3 年患者生存率分别为 HIV 感染者的 81.2%和 HIV 未感染者的 86.4%，P 值=0.34）。总之，在美国，非病毒性肝病现在是 HIV 感染者 LT 的主要适应证，并且随着时间的推移，移植后结局有所改善。
