Intention-to-treat survival analysis of HCV/HIV co-infected liver transplant: Is it the waiting list?

Araiz, Juan José (Universidad de Zaragoza) ; Serrano, Trinidad (Universidad de Zaragoza) ; García Gil, Agustín (Universidad de Zaragoza) ; Lacruz, Elena ; Lorente, Sara (Universidad de Zaragoza) ; Sanchez, Jose Ignacio ; Suarez, Miguel Angel (Universidad de Zaragoza)

Resumen: In human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfected patients, the accelerated severity of liver disease, associated comorbidities, and mortality on the waiting list could change the possibility and results of liver transplantation (LT). Intention-to-treat survival analysis (ITTA) can accurately estimate the applicability and efficacy of LT. The primary objective of this study was to compare the survival of patients with HCV with and without HIV infection. We analyzed a cohort of 199 patients with HCV infection enrolled for LT between 1998 and 2015; 17 were also infected with HIV. The patients with HCV/HIV coinfection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%; P¿<¿0.001). ITTA at 1, 3, and 4 years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV coinfection, respectively (Wilcoxon test P¿<¿0.05). The ITTA at 1, 3, 6, and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV coinfection, respectively (log-rank P¿<¿0.05; Wilcoxon test P¿<¿0.01). A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age¿>¿70 years (hazard ratio [HR]¿=¿3.12; P¿<¿0.05), United Network for Organ Sharing status 1 (HR¿=¿10.1; P¿<¿0.01), Model for End-Stage Liver Disease (HR¿=¿1.13; P¿<¿0.001), and HIV coinfection (HR¿=¿2.65; P¿<¿0.05) had independent negative predictive value for survival. In conclusion, our study indicates that HIV coinfection is a factor in mortality prior to transplantation and associated with higher mortality on the waiting list.

Idioma: Inglés

DOI: 10.1002/lt.24474

Año: 2016

Publicado en: LIVER TRANSPLANTATION 22, 9 (2016), 1186-1196
ISSN: 1527-6465

Factor impacto JCR: 3.91 (2016)

Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 19 / 79 = 0.241 (2016) - Q1 - T1
Categ. JCR: TRANSPLANTATION rank: 6 / 25 = 0.24 (2016) - Q1 - T1
Categ. JCR: SURGERY rank: 20 / 196 = 0.102 (2016) - Q1 - T1

Factor impacto SCIMAGO: 1.635 - Hepatology (Q1) - Transplantation (Q1) - Surgery (Q1)

Tipo y forma: Artículo (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)