1062 
Prognostic Factors of Mortality in HCV/HIV-co-infected Liver Transplant Recipients: The FIPSE OLT-HIV-05 - GESIDA 45-05 Cohort Study
Jose Miro*1, M Montejo2, L Castells3, A Rafecas4, P Miralles5, J Fortun6, M Blanes7, M De La Mata8, F Torres1, A Rimola1, and Spanish Olt In Hiv-infected Patients Working Group
1Hosp Clin-IDIBAPS, Univ of Barcelona, Spain; 2Hosp Cruces, Bilbao, Spain; 3Hosp Univ Vall d`Hebron, Barcelona, Spain; 4Hosp Univ de Bellvitge, Barcelona, Spain; 5Hosp Gregorio Maranon, Madrid, Spain; 6Hosp Ramon y Cajal, Madrid, Spain; 7Hosp La Fe, Valencia, Spain; and 8Hosp Univ Reina Sofia, Cordoba, Spain
Background: Recurrent hepatitis C virus (HCV) after orthotopic
liver transplantation is a major cause of graft loss and death. Preliminary
studies suggest poorer survival in HIV-co-infected patients. This study
analyzed the prognostic factors of survival in Spanish HCV/HIV-co-infected
recipients.
Methods: This is a prospective multicenter cohort study of
102 liver transplants performed in Spain since 2002 in HCV/HIV-co-infected
patients. Prognostic factors of mortality were analyzed in the first 60 patients.
Time to death was analyzed using a Cox model, and all covariates with p <0.2
on univariate testing were used to identify independent predictors of mortality
(SAS version 9.1.3).
Results: Median (IQR) age was 41 (38 to 45) years, 77% of
recipients were male and former drug use (77%) was the most common HIV risk
factor. Genotypes 1/4 or 2/3 were diagnosed in 45 (75%) and 14 (23%) cases,
respectively. Pre- MELD and CD4 cell count were 16 (12 to 19) and 273 (180 to 420)
cells/mm3, respectively. All but 1 patient had undetectable plasma
RNA HIV viral load. Efavirenz-based HAART was the most common post- (59%)
treatment. Patients received cyclosporine- or tacrolimus-based regimens in 33%
and 67% of cases, respectively. Median (IQR) follow-up was 15 (8 to 30) months.
Retransplantation was required for 2 patients. Of the 102 patients, 13 died
(22%) of whom 7 (54%) were HCV-related, 3 (23%) were due to post-operative
complications, and 3 (23%) to other causes. Survival rates at 1, 2, 3, and 4
years were 87%, 70%, 64%, and 64%, respectively. The univariate analysis
identified 2 variables independently associated with death: chronic rejection
(p = 0.03) and histological criteria of graft cirrhosis (F4) (p =
0.01). There was a trend of higher mortality for patients developing adverse
events to HAART (p = 0.12) or immunosuppressive drugs (p = 0.10)
and a lower mortality for those patients reaching sustained virological
response with anti-HCV therapy (p = 0.28). None of the 7 patients with sustained
virological response died. Baseline CD4 count, MELD score, acute rejection,
type of HAART regimen, and hepatocellular carcinoma were not associated with
death. Multivariate analysis identified only graft cirrhosis (HR; 95%CI: 4.08; 1.36
to 12.23) as independently associated with death.
Conclusions: Orthotopic liver transplantation is a safe and
effective short-term procedure in HCV/HIV-co-infected recipients. However, developing
graft cirrhosis due to HCV reinfection can compromise mid- and long-term
survival, so, new strategies are necessary to improve the outcome of anti-HCV
therapy.
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