Long-Term Outcomes of Orthotopic Liver Transplantation in Human Immunodeficiency Virus–Infected Patients and Comparison With Human Immunodeficiency Virus–Negative Cases

Abstract Human immunodeficiency virus (HIV) positivity is no longer a contraindication for orthotopic liver transplantation (OLT) due to the efficacy of antiretroviral therapy. The aim of this study was to compare OLT among HIV-positive and HIV-negative cohorts; the results were also stratified for hepatitis C virus (HCV) coinfection. Between 2004 and 2009, all HIV-infected patients undergoing OLT from heart-beating deceased donors (n = 27) were compared with an HIV-negative cohort (n = 27). The pure HCV infection rate was similar between HIV-positive and HIV-negative subjects (63% each). HIV-positive recipients were younger ( P = .013). The CD4 count for HIV-positive subjects was 376 ± 156 at transplantation. The mean model for end-stage liver disease (MELD) score at transplantation was 15 ± 7 in both groups ( P = .92). No differences were observed for donor age ( P = .72) or time on the waiting list ( P = .56). The median follow-up was 26 (range, 1–64) and 27 months (range, 1–48) for HIV and non-HIV recipients, respectively ( P = .85). The estimated 1-, 3-, and 5-year patient and graft survival rates were 88%, 83%, and 83% versus 100%, 73%, and 73% ( P = .95), and 92%, 87%, and 87% versus 95%, 88%, and 88% ( P = .59) for HIV and non-HIV cases, respectively. HIV/HCV–coinfected patients were younger, namely 47 (range, 40–53) versus 52 years (range, 37–68; P = .003), and displayed lower MELD scores at transplantation compared with HCV–mono-infected patients 10 (range, 7–19) versus 17 (range, 8–30) ( P = .008). For HIV/HCV–coinfected and HCV–mono-infected cases the estimated 1-, 3-, and 5-year patients and graft survival rates were respectively 93%, 76%, and 76% versus 100%, 70%, and 60% ( P = .99) and 93%, 84%, and 84% versus 100%, 70%, and 60% ( P = .64), respectively. No difference was observed in the histological severity of HCV recurrence. In conclusion, under specific, well-determined conditions, OLT can be a safe, efficacious procedure in HIV patients.