Pros and cons of liver transplantation in human immunodeficiency virus infected recipients

Table 1 Inclusion criteria for liver transplantation in human immunodeficiency virus - positive patients

Absolute CD4 T cell count above 200 cells/mmc, if history of opportunistic infections or AIDS-defining malignancies	Progressive multifocal leukoencephalopathy, chronic intestinal cryptosporidiosis (> 1 mo duration)
Absolute CD4 T cell count above 100 cells/mmc if absence of previous documented opportunistic infections	Lymphoma or other neoplasms, unless an adequate disease-free period is documented
Undetectable HIV-RNA in blood for patients on C-ART; if not on C-ART, previous documentation of efficacious therapy or genotypic/phenotypic resistance test documenting available post-LT C-ART options
No active (< 1 yr) opportunistic infections, no wasting syndrome or severe malnutrition
Compliance to therapies and to follow-up visits

LT: Liver transplantation; C-ART: Combined antiretroviral therapy; HIV: Human immunodeficiency virus.

Table 2 Factors correlated with mortality and graft loss in human immunodeficiency virus/hepatitis C virus-positive recipients of liver transplantation[14]

Follow-up at 3 yr post-LT	HIV/HIV (89)	HCV (235)	P value
Patient survival (%)	60	79	< 0.001
Graft survival (%)	53	74	< 0.001
Acute rejection (%)	39	24	0.02
Severe HCV reinfection (%)	29	23	0.21

LT: Liver transplantation; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus.

Table 3 Factors predictive of mortality and graft failure at multivariate analysis in human immunodeficiency virus/hepatitis C virus recipients of liver transplantation

Mortality	HR (95%CI), P value	Graft loss	HR (95%CI), P value
HIV infection[14,35]	2.3 (1.3–3.8), 0.0002	BMI < 21[35]	3.2 (1.3–7.7), 0.01
HCV genotype 1[14]	2.14 (1.24–3.41), 0.006	Donor age by decade[35]	1.3 (1.0–1.6), 0.04
Donor index risk[35]	3.03 (1.57–5.83), 0.001	HCV-positive donor[35]	2.5 (1.1–5.6), 0.03
		Combined kidney-lT[35]	3.8 (1.6–9.1), 0.003
		MELD score[14]	1.06 (1.01–1.11), 0.023
		Centers performing < 1 LT/yr[14]	2.82 (1.30–6.94), 0.009
		Treated acute rejection1[35]	2.0 (1.0–4.0), 0.06
		HIV infection[35]	1.9 (1.2–3.1), 0.01

¹In HIV-positive individuals with or without HCV. HCV: Hepatitis C virus; BMI: Body mass index; LT: Liver transplantation; HIV: Human immunodeficiency virus.

Table 4 Comparison of human immunodeficiency virus+ vs human immunodeficiency virus- patients transplanted for hepatocellular carcinoma

Series	Pts number		Milan out		Alfa fetoprotein pre-LT		MiV+		HCC recurrence		Disease free survival (mo)
	HIV+	HIV-	HIV+	HIV-	HIV+	HIV-	HIV+	HIV-	HIV+	HIV-	HIV+	HIV-
Di Benedetto et al[48]	30	125	26.7%	43.2%	157.88	327.64	23.30%	16%	6.7%	14.4%	31.7	29.8
					(1-2882)	(1-22455)					(1.28-68.78)	(0.43-75.79)
Viber et al[49]	16	58	31%	34%	16	13	50%	43%	31%	15%	27	27
					(3-7154)	(1-552)					(14-79)	(2-78)

MiV+: Microvascular invasion present; HCC: Hepatocellular carcinoma; LT: Liver transplantation; HIV: Human immunodeficiency virus.