Beyond the NIH Multicenter HIV Transplant Trial Experience: Outcomes of HIV+ Liver Transplant Recipients Compared to HCV+ or HIV+/HCV+ Coinfected Recipients in the United States

Background. The effectiveness of liver transplant (LT) in human immunodeficiency virus (HIV) and HIV/hepatitis C virus (HCV) coinfected recipients in the United States is unknown. We investigated (i) the effect of HIV on US patient and allograft LT outcomes, compared to HCV+ and HIV/HCV uninfected recipients and (ii) whether LT at centers that participated in the National Institutes of Health (NIH) Solid Organ Transplantation in HIV Trial, reflecting experience and a standardized approach to patient selection, impacted outcomes. Methods. A retrospective cohort study of primary LT recipients transplanted 27 February 2002 through 31 December 2013, categorized by serostatus: HCV+ (n = 20 829), HIV+ (n = 72), HIV+/HCV+ (n = 160), and HIV−/HCV− uninfected (n = 22 926) as reference. Survival was determined using Cox regression, stratified according to center NIH trial participation. Results. HCV (hazard ratio [HR] 1.46, 95% confidence interval [CI], 1.41–1.52) and HIV/HCV coinfection (HR 2.62, 95% CI, 2.06–3.33) were associated with mortality; HIV monoinfection was not (HR 1.37, 95% CI, .86–2.18). This was unchanged after stratification on NIH trial participation, although mortality was higher in NIH-enrolling (HIV+: HR 1.65, 95% CI, .93–2.92; HIV+/HCV+: HR 3.15, 95% CI, 2.32–4.28) than in non-enrolling centers (HIV+: HR 1.03, 95% CI, .43–2.47, HIV+/HCV+: HR 2.55, 95% CI, 1.64–3.96). Although allograft loss was higher in HIV/HCV coinfected recipients transplanted at enrolling (HR 2.64, 9%% CI, 1.91–3.64) vs nonenrolling centers (HR 2.22, 95% CI, 1.41–3.49), there was no difference in HIV and HCV monoinfected patients. Conclusions. HIV+ LT recipient outcomes were superior to HCV+ or HIV/HCV coinfected recipients. Despite a standardized approach and plausibly more experience with HIV patients, transplantation at NIH study center did not improve outcomes.