Paper # 688 
Outcomes in HIV/HCV Hemophilic vs Non-hemophilic Transplant Candidates
Margaret Ragni*1, M DeVera1, M Roland2, M Wong3, V Stosor4, K Sherman5, D Hardy6, E Blumberg7, B Barin8, and P Stock2
1Univ of Pittsburgh, PA, US; 2Univ of California, San Francisco, US; 3Beth Israel Deaconess Med Ctr, Harvard Med Sch, Boston, MA, US; 4Northwestern Univ, Chicago, IL, US; 5Univ of Cincinnati, OH, US; 6Cedars-Sinai Med Ctr, Los Angeles, CA, US; 7Univ of Pennsylvania, Philadelphia, US; and 8EMMES Corp, Rockville, MD, US
Background: Hepatitis C virus infection is the major
cause of end-stage liver disease, and it is the major indication for liver transplantation
among HIV-infected individuals. Individuals with hemophilia (H), in contrast to
those without hemophilia (NH), acquired HCV at a very young age, specifically
with the first transfusion in the first years of life. Thus, we sought to
determine whether HIV/HCV co-infected hemophilic men experience poorer OLTX
outcomes than those without hemophilia.
Methods: MELD, CD4, HIV VL, HCV VL, HAART therapy, event
rates and time-to-events, including transplant, rejection, and mortality, were
compared between co-infected H and NH, from the same centers, participating in
the multi-center HIV transplant study (HIVTR). Statistical analysis included Wilcoxon
rank-sum test for comparison of continuous variables, Fisher’s exact test for
comparison of categorical variables, and log-rank test for comparison of
time-to-event curves.
Results: Of 100 HIV/HCV enrolled candidates, 33
(33%) underwent liver transplantation, including 8 of 16 (50.0%) H and 25 of 84
(29.8%) NH. Currently fewer H transplant candidates remain alive, 3 (18.8%)
than NH, 46 (54.8%); H were more likely to die pre-OLTX, 5 (31.3%), as compared
with NH, 13 (15.5%), P =0.03, primarily from sepsis and multi-organ
failure. Hemophilic candidates reached OLTX (P =0.06) and MELD of
25 (P =0.09) marginally faster than non-hemophilic subjects. Although
H were younger, 42 vs 48 yr, P =0.004, there were no differences between
H and NH in BMI, 24 vs 25, P =0.54, CD4, 321 vs 281/µL, P =0.57,
detectable HIV RNA, 25.0% vs 13.1%, P =0.25, or detectable HCV VL, 100%
vs. 86.9%, P =0.20. Time to post-OLTX death (P =0.67),
graft loss (p=0.86), and treated rejection (P =0.81) were similar. Rejection
rates (95%CI) among H were 27% (7 to 72) at 1-year and 51% (18 to 92) at 3-year;
and among NH were 40% (23 to 64) at 1-year and 48% (28 to 72) at 3-year.
Post-OLTX survival (95%CI) among H was 75% (31 to 93) at 1-year and 56% (15 to 84)
at 3-year; and among NH was 62% (39 to 78) at 1-year and 56% (33 to 74) at 3-year.
Hepatocellular cancer was not a significant predictor of graft loss or
survival.
Conclusions: Among HIV+ hemophilic men,
despite early acquisition of HCV, transplant outcomes appear to be similar to
those in co-infected individuals without hemophilia. However, pre-transplant
mortality appears higher among co-infected hemophilic men. Whether earlier
intervention could reverse this finding is not known.
|
