Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA.
HIV Med. 2021 Sep;22(8):662-673. doi: 10.1111/hiv.13113. Epub 2021 May 8.
Organ failure (OF), a leading cause of death in HIV-positive individuals, is common in patients undergoing liver transplantation (LT). We examined the impact of HIV infection on pre- and post-LT mortalities in cirrhotic patients stratified by the number and type of OFs.
We performed a cross-sectional study and a retrospective cohort study using the US National Inpatient Sample (NIS) and the United Network for Organ Sharing (UNOS) registry data, respectively. Patients who had not yet undergone LT from the NIS database (2010-2014) and patients undergoing LT from the UNOS database (2003-2016) were included in the study.
Analysis of patients (201 348) from the NIS database showed that one [adjusted odds ratio (aOR) 1.531; 95% confidence interval (CI) 1.160-2.023], two (aOR 1.624; 95% CI 1.266-2.083) or three or more OFs (aOR 1.349; 95% CI 1.165-1.562) were associated with higher pre-LT mortality in HIV-infected patients compared with HIV-negative patients with the corresponding number of OFs. In patients without OF, HIV infection was not associated with increased pre-LT mortality. UNOS data for patients undergoing LT (38 942) showed that the presence of two or more OFs was associated with increased post-LT 1-year mortality in HIV-infected patients compared with non-HIV-infected patients with the corresponding number of OFs (aOR 2.342; 95% CI 1.576-3.480). However, in patients with no OF or only one OF, HIV infection was not associated with increased post-LT 1-year mortality (aOR 1.372; 95% CI 0.911-2.068).
The results of this study emphasize the importance of preventing OF development, and justify LT for HIV-infected patients with no or only one OF.
器官衰竭（OF）是 HIV 阳性个体死亡的主要原因之一，在接受肝移植（LT）的患者中很常见。我们研究了 HIV 感染对肝硬化患者 LT 前和 LT 后死亡率的影响，这些患者按 OF 的数量和类型进行分层。
我们分别使用美国国家住院患者样本（NIS）和联合器官共享网络（UNOS）登记数据进行了横断面研究和回顾性队列研究。研究纳入了来自 NIS 数据库（2010-2014 年）中尚未接受 LT 的患者和来自 UNOS 数据库（2003-2016 年）中接受 LT 的患者。
对 NIS 数据库中患者（201348 例）的分析显示，与相应数量 OF 的 HIV 阴性患者相比，存在 1 个（校正比值比[aOR]1.531；95%置信区间[CI]1.160-2.023）、2 个（aOR 1.624；95% CI 1.266-2.083）或 3 个或更多 OF 与 HIV 感染患者 LT 前死亡率较高相关。在没有 OF 的患者中，HIV 感染与 LT 前死亡率增加无关。来自接受 LT 的患者的 UNOS 数据（38942 例）显示，与相应数量 OF 的非 HIV 感染患者相比，存在 2 个或更多 OF 的 HIV 感染患者发生 LT 后 1 年死亡率增加（aOR 2.342；95% CI 1.576-3.480）。然而，在没有 OF 或只有 1 个 OF 的患者中，HIV 感染与 LT 后 1 年死亡率增加无关（aOR 1.372；95% CI 0.911-2.068）。
本研究结果强调了预防 OF 发展的重要性，并为无 OF 或仅 1 个 OF 的 HIV 感染患者提供了 LT 的依据。
