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HIV/HCV Co-Infection: Organ Transplantation and Malignancy
Wednesday, 1:30 - 3:30 pm
Background: HIV-infected patients undergoing transplantation may experience HIV disease progression induced by immunosuppressants and/or accelerated graft failure due to HIV or its treatment. Alternatively, they may experience patient and graft survival rates similar to other patients.
Methods: A pilot, single center, non-randomized, longitudinal evaluation of patient and graft survival and post-transplant complications in subjects who received a liver or kidney transplant and were treated with antiretrovirals and immunosuppressants.
Results: Of the total, 14 subjects received kidney transplants, 9 received liver transplants, and 1 received a liver/kidney transplant (n = 24) between 3/00 and 9/03. Subjects included 23 men and 1 woman, with a median age of 45 (15 to 64); 54% were white, 33% African American, 8% Asian, and 4% Latino. Four (17%) subjects had a prior history of 5 opportunistic complications (CMV, cryptococcal meningitis, MAC, KS, and TB). Median pre-transplant CD4+ T-cell count was 407 (104 to 973). HIV RNA was undetectable in kidney recipients; median HIV RNA was <75 (<75 to 55,100) in liver recipients. HCV infection was present in 4 (40%) liver and 4 (29%) kidney recipients. Median follow-up as of October 1, 2003, is 480 days (8 to 1254). Two subjects died: 1 liver recipient with recurrent HCV infection (15 months) and 1 kidney recipient with pneumonia (6 months). There was one case each of the following: Candida esophagitis, CMV esophagitis, and pulmonary Aspergillus infection. There was no recurrence of prior opportunistic infections. At follow-up, the median CD4+ T-cell count was 255 (8 to 902) and HIV RNA was <75 (<75 to 9600). Rejection occurred in 10 (71%) kidney recipients, the liver/kidney recipient, and one liver recipient. There were 5 cases of delayed graft function in kidney recipients and 1 kidney graft loss due to rejection. Median creatinine is 1.6 (1.1 to 3.2) in kidney recipients. One liver recipient required re-transplantation due to a small for size graft lesion. Recurrent HCV has been documented in 2 liver recipients, 1 of whom received HCV treatment, and progressive HCV in no kidney recipients.
Conclusions: Liver and kidney transplantation appears to be associated with good patient and graft survival and minimal evidence of HIV disease progression despite CD4+ T-cell declines with rejection treatment. There is an unexpectedly high rate of kidney rejection. A multi-site study will definitively address the safety and efficacy of this intervention.
Keywords: Transplantation; Hepatitis; End-Stage Organ Disease