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Tang JX, Zhao D. Current status of liver transplantation for human immunodeficiency virus-infected patients in mainland China. World J Gastroenterol 2024; 30:1958-1962. [PMID: 38681123 PMCID: PMC11045497 DOI: 10.3748/wjg.v30.i14.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/18/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
According to the report from the Chinese Center for Disease Control and Prevention, the prevalence of human immunodeficiency virus (HIV) infection exceeded 1.2 million individuals by the year 2022, with an annual increase of about 80000 cases. The overall prevalence of hepatitis B surface antigen among individuals co-infected with HIV reached 13.7%, almost twice the rate of the general population in China. In addition to the well-documented susceptibility to opportunistic infections and new malignancies, HIV infected patients frequently experience liver-related organ damage, with the liver and kidneys being the most commonly affected. This often leads to the development of end-stage liver and kidney diseases. Therefore, organ transplantation has emerged as an important part of active treatment for HIV infected patients. However, the curative effect is not satisfactory. HIV infection has been considered a contraindication for organ transplantation. Until the emergence of highly active anti-retroviral therapy in 1996, the once intractable replication of retrovirus was effectively inhibited. With prolonged survival, the failure of important organs has become the main cause of death among HIV patients. Therefore, transplant centers worldwide have resumed exploration of organ transplantation for HIV-infected individuals and reached a positive conclusion. This study provides an overview of the current landscape of HIV-positive patients receiving liver transplantation (LT) in mainland China. To date, our transplant center has conducted LT for eight end-stage liver disease patients co-infected with HIV, and all but one, who died two months postoperatively due to sepsis and progressive multi-organ failure, have survived. Comparative analysis with hepatitis B virus-infected patients during the same period revealed no statistically significant differences in acute rejection reactions, cytomegalovirus infection, bacteremia, pulmonary infections, acute kidney injury, new-onset cancers, or vascular and biliary complications.
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Affiliation(s)
- Jian-Xin Tang
- Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518000, Guangdong Province, China
| | - Dong Zhao
- Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518000, Guangdong Province, China
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2
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Chandran S, Stock PG, Roll GR. Expanding Access to Organ Transplant for People Living With HIV: Can Policy Catch Up to Outcomes Data? Transplantation 2024; 108:874-883. [PMID: 37723620 DOI: 10.1097/tp.0000000000004794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Advances in antiretroviral and immunosuppressive regimens have improved outcomes following solid organ transplantation in people living with HIV (PLWH). The HIV Organ Policy and Equity Act was conceived to reduce the discard of HIV-positive organs and improve access to transplant for PLWH. Nevertheless, PLWH continue to experience disproportionately low rates of transplant. This overview examines the hurdles to transplantation in PLWH with end-organ disease, the potential and realized impact of the HIV Organ Policy and Equity Act, and changes that could permit expanded access to organ transplant in this population.
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Affiliation(s)
- Sindhu Chandran
- Department of Medicine, University of California-San Francisco (UCSF), San Francisco, CA
| | - Peter G Stock
- Department of Surgery, University of California-San Francisco (UCSF), San Francisco, CA
| | - Garrett R Roll
- Department of Surgery, University of California-San Francisco (UCSF), San Francisco, CA
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3
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Jacob JS, Shaikh A, Goli K, Rich NE, Benhammou JN, Ahmed A, Kim D, Rana A, Goss JA, Naggie S, Lee TH, Kanwal F, Cholankeril G. Improved Survival After Liver Transplantation for Patients With Human Immunodeficiency Virus (HIV) and HIV/Hepatitis C Virus Coinfection in the Integrase Strand Transfer Inhibitor and Direct-Acting Antiviral Eras. Clin Infect Dis 2023; 76:592-599. [PMID: 36221143 PMCID: PMC10169442 DOI: 10.1093/cid/ciac821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with human immunodeficiency virus (HIV) with and without hepatitis C virus (HCV) coinfection had poor outcomes after liver transplant (LT). Integrase strand transfer inhibitors (INSTIs) and direct-acting antivirals (DAAs) have changed the treatment landscape for HIV and HCV, respectively, but their impact on LT outcomes remains unclear. METHODS This retrospective analysis of adults with HIV monoinfection (n = 246) and HIV/HCV coinfection (n = 286) who received LT compared mortality in patients with HIV who received LT before versus after approval of INSTIs and in patients with HIV/HCV coinfection who received LT before versus after approval of DAAs. In secondary analysis, we compared the outcomes in the different eras with those of propensity score-matched control cohorts of LT recipients without HIV or HCV infection. RESULTS LT recipients with HIV monoinfection did not experience a significant improvement in survival between the pre-INSTI and INSTI recipients with HIV (adjusted hazard ratio [aHR], 0.70 [95% confidence interval {CI}, .36-1.34]). However, recipients with HIV/HCV coinfection in the DAA era had a 47% reduction (aHR, 0.53 [95% CI, .31-9.2] in 1-year mortality compared with coinfected recipients in the pre-DAA era. Compared to recipients without HIV or HCV, HIV-monoinfected recipients had higher mortality during the pre-INSTI era, but survival was comparable between groups during the INSTI era. HIV/HCV-coinfected recipients also experienced comparable survival during the DAA era compared to recipients without HCV or HIV. CONCLUSIONS Post-LT survival for people with HIV monoinfection and HIV/HCV coinfection has improved with the introduction of INSTI and DAA therapy, suggesting that LT has become safer in these populations.
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Affiliation(s)
- Jake Sheraj Jacob
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Anjiya Shaikh
- Department of Internal Medicine, University of Connecticut, Mansfield, Connecticut, USA
| | - Karthik Goli
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Nicole E Rich
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jihane N Benhammou
- Division of Gastroenterology and Hepatology, University of California, Los Angeles, California, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Abbas Rana
- Hepatology Program, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Hepatology Program, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Susanna Naggie
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tzu-Hao Lee
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Hepatology Program, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Fasiha Kanwal
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - George Cholankeril
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Hepatology Program, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
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Lam C, Landry S, Moussa G, Sakr D, Varinot G, Mousseau K, Martel D, Frenette AJ, Ambaraghassi G, Rouleau D, Cantarovich M, Klein MB, Sheehan NL, Lemire B. Pharmacotherapeutic Interventions in People Living With HIV Undergoing Solid Organ Transplantation: A Scoping Review. Transplant Direct 2023; 9:e1441. [PMID: 36733439 DOI: 10.1097/TXD.0000000000001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 01/28/2023] Open
Abstract
The pharmacotherapeutic management of people living with HIV (PLWHIV) undergoing solid organ transplantation (SOT) is clinically challenging, mainly due to the frequent occurrence of complex drug-drug interactions. Although various strategies have been proposed to improve treatment outcomes in these patients, several uncertainties remain, and consensus practice guidelines are just beginning to emerge. The main objective of this scoping review was to map the extent of the literature on the pharmacotherapeutic interventions performed by healthcare professionals for PLWHIV undergoing SOT. Methods We searched Medline, Embase, and the Cochrane databases as well as gray literature for articles published between January 2010 and February 2020. Study selection was performed by at least 2 independent reviewers. Articles describing pharmacotherapeutic interventions in PLWHIV considered for or undergoing SOT were included in the study. Results Of the 12 599 references identified through our search strategy, 209 articles met the inclusion criteria. Results showed that the vast majority of reported pharmacotherapeutic interventions concerned the management of immunosuppressive and antimicrobial therapy, including antiretrovirals. Analysis of the data demonstrated that for several aspects of the pharmacotherapeutic management of PLWHIV undergoing SOT, there were differing practices, such as the choice of immunosuppressive induction and maintenance therapy. Other important aspects of patient management, such as patient counseling, were rarely reported. Conclusions Our results constitute an extensive overview of current practices in the pharmacotherapeutic management of SOT in PLWHIV and identify knowledge gaps that should be addressed to help improve patient care in this specific population.
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Saeed H, Cano EJ, Khan MQ, Yetmar ZA, Smith B, Rizza SA, Badley AD, Mahmood M, Leise MD, Cummins NW. Changing Landscape of Liver Transplantation in the Post-DAA and Contemporary ART Era. Life (Basel) 2022; 12:1755. [PMID: 36362910 PMCID: PMC9693252 DOI: 10.3390/life12111755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 07/30/2023] Open
Abstract
Combination anti-retroviral therapy has drastically improved solid organ transplantation outcomes in persons living with HIV. DAA therapy has led to the successful eradication of HCV. While recent data have suggested improvement in outcomes in HIV/HCV-coinfected liver transplant recipients, temporal trends in patient survival within pre- and post-DAA eras are yet to be elucidated. The UNOS database was utilized to identify deceased donor liver transplant recipients between 1 January 2000 and 30 September 2020 and stratify them by HIV and HCV infection status. A total of 85,730 patients met the inclusion criteria. One-year and five-year patient survival improved (93% and 80%, respectively) for all transplants performed post-2015. For HIV/HCV-coinfected recipients, survival improved significantly from 78% (pre-2015) to 92% (post-2015). Multivariate regression analyses identified advanced recipient age, Black race, diabetes mellitus and decompensated cirrhosis as risk factors associated with higher one-year mortality. Liver transplant outcomes in HIV/HCV-coinfected liver transplant recipients have significantly improved over the last quinquennium in the setting of the highly effective combination of ART and DAA therapy. The presence of HIV, HCV, HIV/HCV-coinfection and active HCV viremia at the time of transplant do not cause higher mortality risk in liver transplant recipients in the current era.
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Affiliation(s)
- Huma Saeed
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Edison J. Cano
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Mohammad Qasim Khan
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, USA
| | - Zachary A. Yetmar
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Byron Smith
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55902, USA
| | - Stacey A. Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Andrew D. Badley
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Michael D. Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, USA
| | - Nathan W. Cummins
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55902, USA
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Malashenko AA, Tsyplina EY, Krasnov AO, Anishchenko VV, Krasnov OA. THE CURRENT STATE OF THE PROBLEM IN ORGAN TRANSPLANTATION IN HIV-INFECTED PATIENTS ABROAD AND IN THE RUSSIAN FEDERATION. jour 2022. [DOI: 10.38181/2223-2427-2022-3-42-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The work is based on a retrospective analysis of literature data covering tactical approaches, indications and contraindications, treatment results in patients with HIV infection who underwent organ transplantation. The analysis of the most up-to-date publications on organ transplantation in HIV-infected patients in the Russian Federation and abroad has been carried out. The criteria under which the transplantation of an HIV-infected patient is most favorable are noted. Cases of transplantation with subsequent results are described: donor (HIV-) – recipient (HIV+), donor (HIV+) – RECIPIENT (HIV+) and donor (HIV+) – RECIPIENT (HIV-). The main purpose of the review is to analyze modern foreign and domestic literature on the issue of tactical approaches to organ transplantation in HIV-infected patients. It has been established that different countries have different approaches to organ transplantation in HIV-infected patients.
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Affiliation(s)
- A. A. Malashenko
- Federal state Institution Medical and Sanitary Unit No. 42 of the Federal Penitentiary Service of Russia, branch «Hospital No. 1»
| | - E. Yu. Tsyplina
- Federal State Budgetary Educational Institution of Higher Education «Siberian State Medical University»
| | - A. O. Krasnov
- State Autonomous Health Institution "Kuzbass Clinical Emergency Hospital named after M. A. Podgorbunsky
| | - V. V. Anishchenko
- Federal State Budgetary Educational Institution of Higher Education «Novosibirsk State Medical University», Department of Surgery, Faculty of Advanced Training and Professional Retraining of Doctors; Avicena Medical Center JSC, Mother and Child Group of companies
| | - O. A. Krasnov
- Federal Budgetary Educational Institution of Higher Education Kemerovo State Medical University; Department of General, Faculty Surgery and Urology, I. A. Kolpinsky Clinical Consulting and Diagnostic Center, Polyclinic No. 1
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Lushniak SA, Durand CM. Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new. Curr Opin Infect Dis 2022; 35:321-329. [PMID: 35849522 PMCID: PMC9718437 DOI: 10.1097/qco.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF THE REVIEW Passage of the HOPE Act and the advent of direct-acting antiviral (DAA) therapies have allowed for expansion of the donor organ pool to include donors with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), thus providing new opportunities for waitlist candidates. This article provides updates on recent studies in solid organ transplantation (SOT) utilizing donors with HIV and HCV. RECENT FINDINGS The first pilot studies of kidney and liver transplantation from donors-with-HIV to recipients-with-HIV (HIV D+/R+) show robust patient survival, comparable graft survival to transplantation from donors without HIV (HIV D-/R+) and no increased rates of HIV breakthrough. The number of HIV D+ organs utilized has been lower than initial estimates due to several potential factors. With high numbers of overdose deaths from the opioid epidemic, there have been more HCV D+ organs available, leading to transplantation in recipients without HCV (HCV D+/R-) in combination with DAAs. Outcomes in both abdominal and thoracic HCV D+/R transplantation are excellent. SUMMARY With recent findings of good outcomes in both HIV D+/R+ and HCV D+/R- SOT, we feel the evidence supports both practices as standard clinical care options to mitigate organ shortage and reduce waitlist mortality.
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Affiliation(s)
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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8
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McCain JD, Chascsa DM. Special Considerations in the Management of HIV and Viral Hepatitis Coinfections in Liver Transplantation. Hepat Med 2022; 14:27-36. [PMID: 35514530 PMCID: PMC9063796 DOI: 10.2147/hmer.s282662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Modern therapies for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus have become so effective that patients treated for these conditions can have normal life-expectancies. Suitable livers for transplantation remain a scarce and valuable resource. As such, significant efforts have been made to expand donation criteria at many centers. This constant pressure, coupled with the increasing effectiveness of antiviral therapies, has meant that more and more patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) may be considered appropriate donors in the right circumstances. Patients with these infections are also more likely to be considered appropriate transplantation recipients than in the past. The treatment of HBV, HCV, and HIV after liver transplantation (LT) can be challenging and complicated by viral coinfections. The various pharmaceutical agents used to treat these infections, as well as the immunosuppressants used post-LT must be carefully balanced for maximum efficacy, and to avoid resistance and drug–drug interactions.
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Affiliation(s)
- Josiah D McCain
- Department of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA
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Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611 USA
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10
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Durand CM, Florman S, Motter JD, Brown D, Ostrander D, Yu S, Liang T, Werbel WA, Cameron A, Ottmann S, Hamilton JP, Redd AD, Bowring MG, Eby Y, Fernandez RE, Doby B, Labo N, Whitby D, Miley W, Friedman-Moraco R, Turgeon N, Price JC, Chin-Hong P, Stock P, Stosor V, Kirchner V, Pruett T, Wojciechowski D, Elias N, Wolfe C, Quinn TC, Odim J, Morsheimer M, Mehta SA, Rana MM, Huprikar S, Massie A, Tobian AA, Segev DL. HOPE in action: A prospective multicenter pilot study of liver transplantation from donors with HIV to recipients with HIV. Am J Transplant 2022; 22:853-864. [PMID: 34741800 PMCID: PMC9997133 DOI: 10.1111/ajt.16886] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 01/25/2023]
Abstract
Liver transplantation (LT) from donors-with-HIV to recipients-with-HIV (HIV D+/R+) is permitted under the HOPE Act. There are only three international single-case reports of HIV D+/R+ LT, each with limited follow-up. We performed a prospective multicenter pilot study comparing HIV D+/R+ to donors-without-HIV to recipients-with-HIV (HIV D-/R+) LT. We quantified patient survival, graft survival, rejection, serious adverse events (SAEs), human immunodeficiency virus (HIV) breakthrough, infections, and malignancies, using Cox and negative binomial regression with inverse probability of treatment weighting. Between March 2016-July 2019, there were 45 LTs (8 simultaneous liver-kidney) at 9 centers: 24 HIV D+/R+, 21 HIV D-/R+ (10 D- were false-positive). The median follow-up time was 23 months. Median recipient CD4 was 287 cells/µL with 100% on antiretroviral therapy; 56% were hepatitis C virus (HCV)-seropositive, 13% HCV-viremic. Weighted 1-year survival was 83.3% versus 100.0% in D+ versus D- groups (p = .04). There were no differences in one-year graft survival (96.0% vs. 100.0%), rejection (10.8% vs. 18.2%), HIV breakthrough (8% vs. 10%), or SAEs (all p > .05). HIV D+/R+ had more opportunistic infections, infectious hospitalizations, and cancer. In this multicenter pilot study of HIV D+/R+ LT, patient and graft survival were better than historical cohorts, however, a potential increase in infections and cancer merits further investigation.
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Affiliation(s)
- Christine M. Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sander Florman
- Recanati-Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY
| | - Jennifer D. Motter
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Diane Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Darin Ostrander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tao Liang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A. Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shane Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James P. Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mary G. Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yolanda Eby
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | | | | | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Peter Chin-Hong
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Peter Stock
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Cameron Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jonah Odim
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Megan Morsheimer
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sapna A. Mehta
- New York University Langone Transplant Institute, New York, NY
| | - Meenakshi M. Rana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York NY
| | - Shirish Huprikar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York NY
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Shimada S, Ivanics T, Kitajima T, Shamaa T, Rizzari M, Collins K, Yoshida A, Abouljoud M, Moonka D, Zhang J, Lu M, Nagai S. Improvements in liver transplant outcomes in patients with HCV/HIV coinfection after the introduction of direct‐acting antiviral therapies. Transpl Infect Dis 2022; 24:e13808. [DOI: 10.1111/tid.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Shingo Shimada
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Tommy Ivanics
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Toshihiro Kitajima
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Tayseer Shamaa
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Michael Rizzari
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Kelly Collins
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Atsushi Yoshida
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Marwan Abouljoud
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
| | - Dilip Moonka
- Division of Gastroenterology and Hepatology Henry Ford Hospital Detroit MI USA
| | - Jiaqi Zhang
- Department of Public Health Sciences Henry Ford Hospital Detroit MI USA
| | - Mei Lu
- Department of Public Health Sciences Henry Ford Hospital Detroit MI USA
| | - Shunji Nagai
- Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Detroit MI USA
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12
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Zimmerer JM, Ringwald BA, Chaudhari SR, Han J, Peterson CM, Warren RT, Hart MM, Abdel-Rasoul M, Bumgardner GL. Invariant NKT Cells Promote the Development of Highly Cytotoxic Multipotent CXCR3 +CCR4 +CD8 + T Cells That Mediate Rapid Hepatocyte Allograft Rejection. J Immunol 2021; 207:3107-3121. [PMID: 34810223 PMCID: PMC9124232 DOI: 10.4049/jimmunol.2100334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022]
Abstract
Hepatocyte transplant represents a treatment for metabolic disorders but is limited by immunogenicity. Our prior work identified the critical role of CD8+ T cells, with or without CD4+ T cell help, in mediating hepatocyte rejection. In this study, we evaluated the influence of invariant NKT (iNKT) cells, uniquely abundant in the liver, upon CD8-mediated immune responses in the presence and absence of CD4+ T cells. To investigate this, C57BL/6 (wild-type) and iNKT-deficient Jα18 knockout mice (cohorts CD4 depleted) were transplanted with allogeneic hepatocytes. Recipients were evaluated for alloprimed CD8+ T cell subset composition, allocytotoxicity, and hepatocyte rejection. We found that CD8-mediated allocytotoxicity was significantly decreased in iNKT-deficient recipients and was restored by adoptive transfer of iNKT cells. In the absence of both iNKT cells and CD4+ T cells, CD8-mediated allocytotoxicity and hepatocyte rejection was abrogated. iNKT cells enhance the proportion of a novel subset of multipotent, alloprimed CXCR3+CCR4+CD8+ cytolytic T cells that develop after hepatocyte transplant and are abundant in the liver. Alloprimed CXCR3+CCR4+CD8+ T cells express cytotoxic effector molecules (perforin/granzyme and Fas ligand) and are distinguished from alloprimed CXCR3+CCR4-CD8+ T cells by a higher proportion of cells expressing TNF-α and IFN-γ. Furthermore, alloprimed CXCR3+CCR4+CD8+ T cells mediate higher allocytotoxicity and more rapid allograft rejection. Our data demonstrate the important role of iNKT cells in promoting the development of highly cytotoxic, multipotent CXCR3+CCR4+CD8+ T cells that mediate rapid rejection of allogeneic hepatocytes engrafted in the liver. Targeting iNKT cells may be an efficacious therapy to prevent rejection of intrahepatic cellular transplants.
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Affiliation(s)
- Jason M Zimmerer
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Bryce A Ringwald
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, OH
| | - Sachi R Chaudhari
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Jing Han
- Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH; and
| | - Chelsea M Peterson
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Robert T Warren
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Madison M Hart
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | | | - Ginny L Bumgardner
- Comprehensive Transplant Center, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH;
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13
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Werbel WA, Durand CM. Clearing the hepatitis hurdle: Obstacles and opportunities in liver transplantation for people with HIV. Am J Transplant 2021; 21:2931-2932. [PMID: 33856113 DOI: 10.1111/ajt.16608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/25/2023]
Affiliation(s)
- William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Campos-Varela I, Dodge JL, Terrault NA, Brandman D, Price JC. Nonviral liver disease is the leading indication for liver transplant in the United States in persons living with human immunodeficiency virus. Am J Transplant 2021; 21:3148-3156. [PMID: 33749113 PMCID: PMC8522205 DOI: 10.1111/ajt.16569] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/09/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Abstract
We evaluated whether indications for liver transplantation (LT) have changed among people with/without human immunodeficiency virus (HIV) infection and compared LT outcomes and trends by HIV serostatus. LT recipients (2008-2018) from the United Network for Organ Sharing and Organ Procurement and Transplantation Network (UNOS/OPTN) were identifed. Among 62 195 LT recipients, 352 (0.6%) were HIV-infected. The proportion of HIV-infected patients increased over time (P trend = .001), as did the number of transplant centers performing LT for HIV-infected recipients; average annual percentage change of 9.2% (p < .001). Nonviral causes became the leading indication in 2015 for HIV-uninfected and in 2018 for HIV-infected (P trend < .001). Three-year cumulative patient survival rates were 77.5%, for HIV-infected and 84.6%, for HIV-uninfected (p = .15). Over time, graft and patient survival rates improved for both HIV-infected and uninfected (p < .001). Among HCV-infected LT recipients, 3-year patient survival rates were 72.5% for HIV-infected and 81.8% for HIV-uninfected (p = .02). However, in a subanalysis restricted to 2014-2018, differences in graft and patient survival by HIV serostatus were no longer observed (3-year patient survival rates were 81.2% for HIV-infected and 86.4% for HIV-uninfected, p = .34). In conclusion, in the United States, nonviral liver disease is now the leading indication for LT in HIV-infected patients, and posttransplant outcomes have improved over time.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Vall d’Hebron Hospital Universitari, Vall d’Hebron Institut de Recerca, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Jennifer L. Dodge
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California,Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Norah A. Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Danielle Brandman
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer C. Price
- Department of Medicine, University of California San Francisco, San Francisco, California
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15
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Griffin D, Kotecha S, Basu G, Gow P, Lau J, Morrissey CO, Hoy JF. HIV and Solid Organ Transplantation: A 15-Year Retrospective Audit at a Tertiary Australian Transplant Centre. Intern Med J 2021; 52:1780-1790. [PMID: 34139100 DOI: 10.1111/imj.15423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 06/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of end-stage organ disease in people living with HIV (PLWH) is increasing, as people live longer due to potent, tolerable antiretroviral therapy. Consequently, the number of PLWH who would benefit from solid organ transplant (SOT) is rising. Solid organ transplantation experience in PLWH in Australia remains limited. The aim of this study was to retrospectively review the outcomes for SOT in PLWH in Victoria, Australia. METHODS A retrospective cohort study of PLWH undergoing SOT over a 15-year period was performed. Adult PLWH over 18 years of age were eligible and identified from the Victorian HIV Service database. Descriptive statistics were used to summarise baseline demographics and clinical data, and outcomes following SOT. RESULTS Nine virologically-suppressed PLWH underwent SOT from HIV-negative donors; 5 kidneys, 2 livers, and 2 bilateral sequential lung transplants. All patients were male, with a median age of 57.3 years (IQR 54.3-60.1), CD4 count of 485 (IQR 342-835) at transplantation, and comorbidities were common at baseline. After a median follow up of 3.9 years (IQR 2.7-7.6), 8 (89%) patents were alive, 7 (78%) had functioning grafts, though 5 (56%) experienced organ rejection. Infections were common. Two patients required modification to their antiretroviral therapy due to significant drug-drug interactions, prior to transplant, while 5 (56%) had modifications post-SOT. No patients experienced HIV virologic failure. CONCLUSION PLWH with end-stage organ disease experience good clinical and functional outcomes, and should be considered for SOT where indicated. However, multidisciplinary planning and care is essential to optomise care in this patient group. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dwj Griffin
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - S Kotecha
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia
| | - G Basu
- Department of Renal Medicine, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - P Gow
- Department of Gastroenterology, Austin Hospital, Melbourne, Australia
| | - Jsy Lau
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - C O Morrissey
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - J F Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
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16
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Cotter TG, Wang J, Lieber SR, Odenwald MA, Rich NE, Marrero JA, Singal AG, Mitchell MC, Aronsohn A, Charlton M, Fung J. "Raising HOPE": Improved Outcomes for HIV/HCV-coinfected Liver Transplant Recipients in the Direct-acting Antiviral Era. Transplant Direct 2021; 7:e707. [PMID: 34124343 DOI: 10.1097/TXD.0000000000001154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 12/11/2022] Open
Abstract
The 2013 HIV Organ Policy Equity Act has increased liver transplantation (LT) in HIV+ patients; however, transplant centers may remain reluctant to perform LT in HIV/hepatitis C virus (HCV)-coinfected patients due to inferior outcomes. We aimed to assess how direct-acting antivirals (DAAs) have impacted HIV+/HCV+-coinfected LT recipient outcomes.
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17
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Fan X, Fang J, Wu X, Poulsen K, Miyata T, Kim A, Yu L, Wang X, Zhang X, Zhang K, Han Q, Liu Z. Effect of HIV infection on pre- and post-liver transplant mortality in patients with organ failure. HIV Med 2021; 22:662-673. [PMID: 33964108 DOI: 10.1111/hiv.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Organ failure (OF), a leading cause of death in HIV-positive individuals, is common in patients undergoing liver transplantation (LT). We examined the impact of HIV infection on pre- and post-LT mortalities in cirrhotic patients stratified by the number and type of OFs. METHODS We performed a cross-sectional study and a retrospective cohort study using the US National Inpatient Sample (NIS) and the United Network for Organ Sharing (UNOS) registry data, respectively. Patients who had not yet undergone LT from the NIS database (2010-2014) and patients undergoing LT from the UNOS database (2003-2016) were included in the study. RESULTS Analysis of patients (201 348) from the NIS database showed that one [adjusted odds ratio (aOR) 1.531; 95% confidence interval (CI) 1.160-2.023], two (aOR 1.624; 95% CI 1.266-2.083) or three or more OFs (aOR 1.349; 95% CI 1.165-1.562) were associated with higher pre-LT mortality in HIV-infected patients compared with HIV-negative patients with the corresponding number of OFs. In patients without OF, HIV infection was not associated with increased pre-LT mortality. UNOS data for patients undergoing LT (38 942) showed that the presence of two or more OFs was associated with increased post-LT 1-year mortality in HIV-infected patients compared with non-HIV-infected patients with the corresponding number of OFs (aOR 2.342; 95% CI 1.576-3.480). However, in patients with no OF or only one OF, HIV infection was not associated with increased post-LT 1-year mortality (aOR 1.372; 95% CI 0.911-2.068). CONCLUSIONS The results of this study emphasize the importance of preventing OF development, and justify LT for HIV-infected patients with no or only one OF.
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Affiliation(s)
- X Fan
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - J Fang
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - X Wu
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - K Poulsen
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - T Miyata
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - A Kim
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - L Yu
- Department of Inflammation and Immunity, Center for Liver Disease Research, Cleveland Clinic, Cleveland, OH, USA
| | - X Wang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - X Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - K Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Q Han
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Z Liu
- Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Fengdong New Town (International) Hospital, Xi'an, Shaanxi, China
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18
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Mejia CD, Malat GE, Boyle SM, Ranganna K, Lee DH. Experience with a six-month regimen of Pneumocystis pneumonia prophylaxis in 122 HIV-positive kidney transplant recipients. Transpl Infect Dis 2020; 23:e13511. [PMID: 33217136 DOI: 10.1111/tid.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
Anti-Pneumocystis pneumonia (PCP) prophylaxis is recommended for 3 to 6 months post-transplant in HIV-negative kidney transplant recipients. For HIV-positive kidney transplant recipients, there is no definite duration of primary prophylaxis and is often prescribed life-long. The objective of this study was to determine the incidence of PCP in HIV-positive recipients who received 6 months of prophylaxis with trimethoprim-sulfamethoxazole or an alternative agent. One hundred and twenty-two HIV-positive recipients received a kidney transplant from 2001 to 2017 at Hahnemann University Hospital. Most patients received induction immunosuppression with an IL-2 receptor antagonist, with or without intravenous immunoglobulin. Only one patient received anti-thymocyte globulin. Maintenance immunosuppression included a calcineurin-inhibitor (tacrolimus or cyclosporine), an antiproliferative agent (mycophenolate or sirolimus), and prednisone. Mean CD4 cell count was 461 ± 127 cells/uL prior to transplant and 463 ± 229 cells/μL at 6 to 12 months after transplant. None of the recipients developed PCP after a median follow-up of 2.88 years (IQR 1.16-4.87). Based on our observation, a 6-month regimen of PCP prophylaxis may be sufficient among HIV-positive recipients, similar to those without HIV infection.
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Affiliation(s)
- Christina D Mejia
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory E Malat
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suzanne M Boyle
- Division of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Karthik Ranganna
- Division of Nephrology, Drexel University College of Medicine, West Reading, PA, USA
| | - Dong Heun Lee
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
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19
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Campos-Varela I, Dodge JL, Berenguer M, Adam R, Samuel D, Benedetto FD, Karam V, Belli LS, Duvoux C, Terrault NA. Temporal Trends and Outcomes in Liver Transplantation for Recipients With HIV Infection in Europe and United States. Transplantation 2020; 104:2078-2086. [PMID: 32969987 PMCID: PMC7919403 DOI: 10.1097/tp.0000000000003107] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We evaluated trends and outcomes of liver transplantation (LT) recipients with/without HIV infection. METHODS LT recipients between 2008 and 2015 from the United Network for Organ Sharing and Organ Procurement and Transplantation Network and European Liver Transplant Registry were included. Trends and characteristics related to survival among LT recipients with HIV infection were determined. RESULTS Among 73 206 LT patients, 658 (0.9%) were HIV-infected. The proportion of LT HIV-infected did not change over time (P-trend = 0.16). Hepatitis C virus (HCV) as indication for LT decreased significantly for HIV-infected and HIV-uninfected patients (P-trends = 0.008 and <0.001). Three-year cumulative graft survival in LT recipients with and without HIV infection was 64.4% and 77.3%, respectively (P < 0.001), with improvements over time for both, but with HIV-infected patients having greater improvements (P-trends = 0.02 and 0.03). Adjusted risk of graft loss was 41% higher in HIV-infected versus HIV-uninfected (adjusted hazard ratio [aHR], 1.41; P < 0.001). Among HIV-infected, model of end-stage liver disease (aHR, 1.04; P < 0.001), body mass index <21 kg/m (aHR, 1.61; P = 0.006), and HCV (aHR, 1.83; P < 0.001) were associated with graft loss, whereas more recent period of LT 2012-2015 (aHR, 0.58; P = 0.001) and donor with anoxic cause of death (aHR, 0.51; P = 0.007) were associated with lower risk of graft loss. CONCLUSIONS Patients with HIV infection account for only 1% of LTs in United States and Europe, with fewer LT for HCV disease over time. A static rate of LT among HIV-infected patients may reflect improvements in cirrhosis management and/or persistent barriers to LT. Graft and patient survival among HIV-infected LT recipients have shown improvement over time.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jennifer L. Dodge
- Department of Surgery, University of California–San Francisco, San Francisco, CA
| | - Marina Berenguer
- Liver Unit, La Fe University Hospital, Ciberehd, IISLaFe, University of Medicine, Valencia, Spain
| | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, University Paris Sud Villejuif, Paris, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, University Paris Sud Villejuif, Paris, France
- University Paris Sud-Paris Saclay, Paris, France
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincent Karam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, University Paris Sud Villejuif, Paris, France
| | - Luca S. Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - Christophe Duvoux
- Department of Hepatology, University Hospital of Henri Mondor-APHP, Paris Est University (UPEC), Créteil, France
| | - Norah A. Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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20
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Abstract
: With current antiretroviral therapy, the lifespan of newly diagnosed persons with HIV (PWH) approaches that of uninfected persons. However, metabolic abnormalities related to both the disease and the virus itself, along with comorbidities of aging, have resulted in end-organ disease and organ failure as a major cause of morbidity and mortality. Solid organ transplantation is a life-saving therapy for PWH who have organ failure, and the approval of the HIV Organ Policy Equity Act has opened and expanded opportunities for PWH to donate and receive organs. The current environment of organ transplantation for PWH will be reviewed and future directions of research and treatment will be discussed.
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21
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Morales MK, Lambing T, Husson J. Review: Evaluation and Management of the HIV/HCV Co-Infected Kidney or Liver Transplant Candidate. Curr Treat Options Infect Dis 2020. [DOI: 10.1007/s40506-020-00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Merli M, Rossotti R, Travi G, Ferla F, Lauterio A, Angelini Zucchetti T, Alcantarini C, Bargiacchi O, De Carlis L, Puoti M. Sustained virological response with 16-week glecaprevir/pibrentasvir after failure to sofosbuvir/velpatasvir in post-transplant severe HCV recurrence in HIV. Transpl Infect Dis 2019; 21:e13165. [PMID: 31487082 DOI: 10.1111/tid.13165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/20/2019] [Accepted: 08/25/2019] [Indexed: 12/01/2022]
Abstract
Direct-acting antivirals (DAAs) demonstrated high efficacy and safety even in the post-liver transplant (LT) setting and in HIV-infected patients, but data are very limited in the early post-LT period with the most recently available DAA. Two HIV/HCV-coinfected LT recipients (both grafts from HIV/HCV-negative donors) experienced early HCV recurrence with severe hepatitis and were treated with sofosbuvir/velpatasvir for 12 weeks. Unfortunately, both patients failed: one (genotype 4d) showed virological breakthrough at week 3 with resistance-associated substitutions (RASs) for both NS5A and NS5B, while the other (genotype 1a) experienced virological relapse without RAS. Both progressed to fibrosing cholestatic hepatitis and were successfully retreated with glecaprevir/pibrentasvir for 16 weeks achieving sustained virological response. The higher prevalence of RAS in experienced genotype 4 patients and the long time to viral suppression observed in subjects with fibrosing cholestatic hepatitis should be taken into account, considering longer treatment duration to increase the chances of achieving sustained virological response.
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Affiliation(s)
- Marco Merli
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Rossotti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanna Travi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Ferla
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Andrea Lauterio
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Chiara Alcantarini
- Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital, University of Torino, Torino, Italy
| | - Olivia Bargiacchi
- Infectious Diseases Section, "Maggiore della Carità" Hospital, Novara, Italy
| | - Luciano De Carlis
- Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,School of Medicine, University of Milano-Bicocca, Milano, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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23
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Abstract
PURPOSE OF REVIEW End-stage organ disease prevalence is increasing among HIV-infected (HIV+) individuals. Trial and registry data confirm that solid organ transplantation (SOT) is efficacious in this population. Optimizing access to transplant and decreasing complications represent active frontiers. RECENT FINDINGS HIV+ recipients historically experienced 2-4-fold higher rejection. Integrase strand transferase inhibitors (INSTIs) minimize drug interactions and may reduce rejection along with lymphodepleting induction immunosuppression. Hepatitis C virus (HCV) coinfection has been associated with inferior outcomes, yet direct-acting antivirals (DAAs) may mitigate this. Experience in South Africa and the US HIV Organ Policy Equity (HOPE) Act support HIV+ donor to HIV+ recipient (HIV D+/R+) transplantation. SOT is the optimal treatment for end-stage organ disease in HIV+ individuals. Recent advances include use of INSTIs and DAAs in transplant recipients; however, strategies to improve access to transplant are needed. HIV D+/R+ transplantation is under investigation and may improve access and provide insights for HIV cure and pathogenesis research.
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Affiliation(s)
- William A. Werbel
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
| | - Christine M. Durand
- Department of Medicine, Johns Hopkins University School
of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University
School of Medicine, Baltimore, MD
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24
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Righi E, Ivaldi F, La Rosa A, Carnelutti A, Londero A, Bassetti M. Immunological profiles of HIV-positive recipients of liver transplant. Transpl Immunol 2019; 57:101208. [PMID: 31102654 DOI: 10.1016/j.trim.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Scarce data are available about immune cell frequencies in HIV-positive recipients of liver transplant. Alterations in immune subsets can lead to persistent immune activation and disease progression or reduced HIV-specific responses. In liver transplantation, impaired immune tolerance can lead to organ rejection. METHODS HIV-positive subjects with undetectable HIVRNA and CD4 > 100/mm3 were included. Control groups were non-transplanted HIV-positive patients with similar immunovirological parameters and healthy subjects. B cells (memory, transitional, and mature subsets), T cells (effector TH1, nonclassic TH1, TH17, TH1/17; T regulatory naïve and effector subsets and CD8+ T regulatory cells), and NK cells (CD56dim and CD56bright subsets) were analyzed by flow cytometry. RESULTS A total of 56 patients, including 14 HIV-positive transplant recipients (HIV-LT), 14 HIV-positive controls, and 28 healthy controls were included. Median age of HIV-LT patients was 54.9 years with median time from transplant of 7.6 years. Eleven (79%) were HIV/HCV coinfected. Compared to nontransplanted patients, HIV-LT displayed significantly increased frequency of T CD8+ cells, lower percentage of T CD4+ cell, and lower number of nonclassic TH1, TH1/17 cells and naïve T CD4+ regulatory cells (Tregs). Healthy controls showed increased numbers of B cell subsets and decreased percentage of T effector subpopulations compared to HIV-LT. Compared to HIV-positive patients, healthy controls had higher B cells, NK cells, CD4+ T cells, naïve CD4+ Tregs but lower CD8+ T cells, effector Tregs, CD8+ Tregs, and all T effector cell subsets. CONCLUSIONS Immune cell subpopulations potentially associated with HIV progression and organ rejection were detected in HIV-positive transplant recipients. We confirmed altered frequencies of B, T, and NK cell populations in HIV-positive liver transplant recipients compared to healthy controls. The imbalance among immune cell subsets deserves further studies to identify markers of transplant outcome and potential therapeutic targets.
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Affiliation(s)
- Elda Righi
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy; Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Federico Ivaldi
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Italy
| | - Alessandro La Rosa
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Alessia Carnelutti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Angela Londero
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
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Abstract
INTRODUCTION In the last two decades, an increasing number of people living with HIV (PLWH) have undergone solid-organ and hematopoietic cell transplantation as a treatment of end-stage organ and hematological diseases, respectively. Although transplant outcomes are more than satisfactory, transplantation in PLWH is still challenging for clinicians because of concerns regarding potentially higher rates of infective complications, higher risks of allograft rejection, and drug-drug interactions between antiretroviral drugs and immunosuppressive agents. AREAS COVERED This review provides an overview of transplantation in PLWH, with focus on the management of combination antiretroviral therapy in this population. EXPERT OPINION Solid-organ and hematopoietic cell transplantations should be proposed without any reservation to all PLWH who may benefit from them. Particular attention should be paid to possible drug-drug interactions between antiretrovirals and immunosuppressive agents; moreover, when feasible, integrase strand transfer inhibitor-based antiretroviral regimens should be preferred to protease and non-nucleoside reverse transcriptase inhibitors. Considering the worse prognosis in HIV/hepatitis C virus (HCV) transplant recipients, treatment of HCV with new direct-acting antivirals (DAAs) represents a key issue in the management of this population. However, the timing of treatment (before or early after transplant) should be individualized by considering short-term prognosis, access to transplant, and comorbidities.
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Affiliation(s)
- Vincenzo Spagnuolo
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
| | - Caterina Uberti-Foppa
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
| | - Antonella Castagna
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Clinic of Infectious Diseases , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute , Milan , Italy
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26
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Blumberg EA, Rogers CC. Solid organ transplantation in the HIV-infected patient: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13499. [PMID: 30773688 DOI: 10.1111/ctr.13499] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the management of transplantation in HIV-infected individuals. Transplantation has become the standard of care for patients with HIV and end-stage kidney or liver disease. Although less data exist for thoracic organ and pancreas transplantation, it is likely that transplantation is also safe and effective for these recipients as well. Despite what is typically a transient decline in CD4+ T lymphocytes, HIV remains well controlled and infection risks are similar to those of HIV-uninfected transplant recipients. The availability of effective directly active antivirals for the treatment of Hepatitis C is likely to improve outcomes in HIV and HCV co-infected individuals, a population previously noted to have decreased survival. Drug interactions remain an important consideration, and integrase inhibitor-based regimens are preferred due to the absence of interactions with calcineurin and mTOR inhibitors. Additionally, despite the use of more potent immunosuppression, rejection rates exceed those found in HIV-uninfected recipients. Ongoing research evaluating HIV-positive organ donors may provide support for utilizing these donors for HIV-positive patients in need of transplantation.
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Affiliation(s)
- Emily A Blumberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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27
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Pierrotti LC, Litvinov N, Costa SF, Azevedo LSFD, Strabelli TMV, Campos SV, Odongo FCA, Reusing-Junior JO, Song ATW, Lopes MIBF, Batista MV, Lopes MH, Maluf NZ, Caiaffa-Filho HH, de Oliveira MS, Sousa Marques HHD, Abdala E. A Brazilian university hospital position regarding transplantation criteria for HIV-positive patients according to the current literature. Clinics (Sao Paulo) 2019; 74:e941. [PMID: 30942282 PMCID: PMC6432843 DOI: 10.6061/clinics/2019/e941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection.Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.
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Affiliation(s)
- Lígia Camera Pierrotti
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Nadia Litvinov
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Figueiredo Costa
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Sérgio Fonseca de Azevedo
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tânia Mara Varejão Strabelli
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Transplante Cardiaco, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Vidal Campos
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Pneumologia, Grupo de Transplante Pulmonar, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fatuma Catherine Atieno Odongo
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jose Otto Reusing-Junior
- Servico de Transplante Renal, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alice Tung Wan Song
- Divisao de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Max Igor Banks Ferreira Lopes
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marjorie Vieira Batista
- Divisao de Molestias Infecciosas, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marta Heloisa Lopes
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Natalya Zaidan Maluf
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Imunologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hélio Helh Caiaffa-Filho
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Biologia Molecular, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Maura Salarolli de Oliveira
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo Controle de Infeccao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Heloisa Helena de Sousa Marques
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca (ICr), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edson Abdala
- Subcomite de Infeccao em Imunodeprimidos, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Molestias Infecciosas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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28
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Cohen JB, Locke JE, Shelton B, Reed RD, Mustian M, MacLennan P, Forde KA, Reese PP, Sawinski D. Disparity in access to kidney allograft offers among transplant candidates with human immunodeficiency virus. Clin Transplant 2019; 33:e13466. [PMID: 30578590 PMCID: PMC6386602 DOI: 10.1111/ctr.13466] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/16/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite a survival benefit from transplantation and acceptable outcomes, patients with human immunodeficiency virus (HIV+) face barriers to kidney transplantation. Little is known about the acceptance or decline of organ offers on their behalf because waitlist registry data do not include HIV serostatus. METHODS We performed a retrospective cohort study using match run data from the Organ Procurement and Transplantation Network, including every kidney offer from May 1, 2007, to July 3, 2013. HIV and hepatitis C virus (HCV) serostatus were obtained by merging the match run with clinical data from a large dialysis provider. We used Cox proportional hazards modeling to evaluate differences in time to the first organ offer and to transplantation. A total of 35 646 uninfected, 2213 HCV+, 418 HIV+, and 71 HIV+/HCV+ candidates received organ offers during the study period. RESULTS Compared to uninfected candidates, HIV+ candidates had a significantly lower likelihood of receiving a first offer (adjusted hazard ratio [aHR] 0.88, 95% confidence interval [CI] 0.79-0.99) and undergoing transplantation (aHR 0.82, 95% CI: 0.68-0.98) after receiving a first offer; HCV+ candidates had a similar likelihood of receiving a first offer (aHR 0.98, 95% CI: 0.92-1.03) and greater likelihood of transplantation after receiving a first offer (aHR 1.23, 95% CI: 1.12-1.36). CONCLUSIONS HIV+ candidates had a significantly longer wait until their first organ offer and to transplantation. Efforts to increase their access to transplantation are needed.
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Affiliation(s)
- Jordana B. Cohen
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jayme E. Locke
- Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
| | - Brittany Shelton
- Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
| | - Rhianon D. Reed
- Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
| | - Margaux Mustian
- Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
| | - Paul MacLennan
- Department of Surgery, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL
| | - Kimberly A. Forde
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Peter P. Reese
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Deirdre Sawinski
- Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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29
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Miro JM, Grossi PA, Durand CM. Challenges in solid organ transplantation in people living with HIV. Intensive Care Med 2019; 45:398-400. [PMID: 30637443 DOI: 10.1007/s00134-019-05524-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/06/2019] [Indexed: 12/17/2022]
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30
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Abstract
Human immunodeficiency virus (HIV) has become a chronic disease with a near normal life span resulting in increased risk of organ failure. HIV organ transplantation is a proven and accepted intervention in appropriately selected cases. HIV-positive organ transplantation into HIV-positive recipients is in its nascent stages. Hepatitis C virus, high rates of organ rejection, and immune dysregulation are significant remaining barriers to overcome. This article provides an overview of the transplantation needs in the HIV population focusing on kidney and liver transplants.
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Affiliation(s)
- Alan J Taege
- Department of Infectious Disease, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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31
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Mazzola G, Adamoli L, Calvaruso V, Macaluso FS, Colletti P, Mazzola S, Cervo A, Trizzino M, Di Lorenzo F, Iaria C, Prestileo T, Orlando A, Di Marco V, Cascio A. Suboptimal performance of APRI and FIB-4 in ruling out significant fibrosis and confirming cirrhosis in HIV/HCV co-infected and HCV mono-infected patients. Infection 2018; 47:409-415. [PMID: 30519966 DOI: 10.1007/s15010-018-1258-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to assess the diagnostic reliability of two indirect biomarkers, APRI and FIB-4, for the staging of liver fibrosis using transient elastography (TE) as reference standard, among HIV/HCV co-infected and HCV mono-infected patients. METHODS This is an observational, retrospective study on subjects who had access to the RESIST HCV from October 2013 to December 2016, a regional network encompassing 22 hospitals and academic centers throughout Sicily. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) < 9.5 kPa (significant fibrosis) and LSM ≥ 12.5 kPa (cirrhosis) were determined by receiver operator characteristics (ROC) curves. RESULTS 238 HIV/HCV co-infected and 1937 HCV mono-infected patients were included. Performances of FIB-4 and APRI for the detection of significant fibrosis and cirrhosis proved to be unsatisfactory, with very high false negative and false positive rates among both cohorts. No significant differences were found after stratification of HIV/HCV co-infected patients for BMI < or ≥ 25, ALT < or ≥ 40 IU/L, ALT < or ≥ 80 IU/L, and presence/absence of a bright liver echo pattern on ultrasonography. CONCLUSIONS Differently from other studies, we detected the unreliability of APRI and FIB-4 for the assessment of liver fibrosis in both HCV mono-infected and HIV/HCV co-infected patients.
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Affiliation(s)
- Giovanni Mazzola
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Lucia Adamoli
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Vincenza Calvaruso
- Di.Bi.M.I.S, Section of Gastroenterology, University of Palermo, Palermo, Italy
| | | | - Pietro Colletti
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Clinical Epidemiology and Cancer Registry Unit, A.O.U.P. "Paolo Giaccone", Palermo, Italy
| | - Adriana Cervo
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Marcello Trizzino
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Chiara Iaria
- ARNAS "Civico-Benefratelli" Hospital, Palermo, Italy
| | | | - Ambrogio Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, 90146, Palermo, Italy
| | - Vito Di Marco
- Di.Bi.M.I.S, Section of Gastroenterology, University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion "G. D'Alessandro", University of Palermo, Palermo, Italy
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32
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Antonini TM, Coilly A, Rossignol E, Fougerou-Leurent C, Dumortier J, Leroy V, Veislinger A, Radenne S, Botta-Fridlund D, Durand F, Houssel-Debry P, Kamar N, Canva V, Perré P, De Ledinghen V, Rohel A, Diallo A, Taburet AM, Samuel D, Pageaux GP, Duclos-Vallée JC; ANRS C023 CUPILT study group. Sofosbuvir-Based Regimens in HIV/HCV Coinfected Patients After Liver Transplantation: Results From the ANRS CO23 CUPILT Study. Transplantation 2018; 102:119-26. [PMID: 28846559 DOI: 10.1097/TP.0000000000001928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A recurrence of hepatitis C virus (HCV) after liver transplantation affects survival in human immunodeficiency virus (HIV)/HCV coinfected patients. This study assessed the efficacy and safety of sofosbuvir (SOF)-based regimens in HIV/HCV coinfected patients after liver transplantation. METHODS Twenty-nine HIV/HCV coinfected transplanted patients receiving tacrolimus-, cyclosporine-, or everolimus-based immunosuppressive therapy were enrolled in the Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation cohort. Their antiviral treatment combined SOF, daclatasvir with or without ribavirin (n = 10/n = 6), or SOF, ledipasvir with or without ribavirin (n = 2/n = 11). RESULTS The median delay between liver transplantation and treatment initiation was 37.5 months (interquartile range [IQR], 14.4-99.2). The breakdown of HCV genotypes was G1, 22 patients (75.9%); G3, 3 patients (10.3%); and G4, 4 patients (13.8%). The treatment indications were HCV recurrence (≥ F1 n = 23) or fibrosing cholestatic hepatitis (n = 6). Before starting SOF, the HCV viral load and CD4 count were 6.7 log10 IU/mL (IQR, 5.9-7.2) and 342 cells/mm (IQR, 172-483), respectively. At week 4, the HCV viral load was less than 15 IU/mL in 12 (42.9%) patients. The overall sustained virological response 12 was 96.6%. No significant drug-drug interactions were observed. CONCLUSIONS SOF-based treatment regimens produced excellent results in HIV/HCV coinfected patients after liver transplantation, suggesting an important change in their prognosis.
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33
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Van Pilsum Rasmussen SE, Bowring MG, Shaffer AA, Henderson ML, Massie A, Tobian AAR, Segev DL, Durand CM. Knowledge, attitudes, and planned practice of HIV-positive to HIV-positive transplantation in US transplant centers. Clin Transplant 2018; 32:e13365. [PMID: 30074638 DOI: 10.1111/ctr.13365] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND HIV+ donor organs can now be transplanted into HIV+ recipients (HIV D+/R+) following the HIV Organ Policy Equity (HOPE) Act. Implementation of the HOPE Act requires transplant center awareness and support of HIV D+/R+ transplants. METHODS To assess center-level barriers to implementation, we surveyed 209 transplant centers on knowledge, attitudes, and planned HIV D+/R+ protocols. RESULTS Responding centers (n = 114; 56%) represented all UNOS regions. Fifty centers (93 organ programs) planned HIV D+/R+ protocols (kidney n = 48, liver n = 34, pancreas n = 8, heart n = 2, lung = 1), primarily in the eastern United States (28/50). Most (91.2%) were aware that HIV D+/R+ transplantation is legal; 21.4% were unaware of research restrictions. Respondents generally agreed with HOPE research criteria except the required experience with ≥5 HIV+ transplants by organ type. Centers planning HIV D+/R+ protocols had higher transplant volume, HIV+ recipient volume, increased infectious risk donor utilization, and local HIV prevalence (P < 0.01). Centers not planning HIV D+/R+ protocols were more likely to believe their HIV+ candidates would not accept HIV+ donor organs (P < 0.001). Most centers (83.2%) supported HIV+ living donation. CONCLUSIONS Although many programs plan HIV D+/R+ transplantation, center-level barriers remain including geographic clustering of kidney/liver programs and concerns about HIV+ candidate willingness to accept HIV+ donor organs.
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Affiliation(s)
| | - Mary Grace Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Aaron A R Tobian
- Transfusion Medicine Division, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Christine M Durand
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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34
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Soriano V, Ramos JM, Barreiro P, Fernandez-Montero JV. AIDS Clinical Research in Spain-Large HIV Population, Geniality of Doctors, and Missing Opportunities. Viruses 2018; 10:v10060293. [PMID: 29848987 PMCID: PMC6024378 DOI: 10.3390/v10060293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.
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Affiliation(s)
- Vicente Soriano
- Infectious Diseases Unit, La Paz University Hospital, 28046 Madrid, Spain.
- UNIR Health Sciences School, 28040 Madrid, Spain.
| | - José M Ramos
- Department of Internal Medicine, General University Hospital, 03010 Alicante, Spain.
| | - Pablo Barreiro
- Infectious Diseases Unit, La Paz University Hospital, 28046 Madrid, Spain.
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35
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Cristelli M, Mazolin M, Manzardo C, Ribeiro M, Cofán F, Santos D, Castel M, Tedesco-Silva H, Moreno A, Diekman F, Miro J, Medina-Pestana J. Sexual acquisition of HIV infection after solid organ transplantation: Late presentation and potentially fatal complications. Transpl Infect Dis 2018; 20:e12894. [DOI: 10.1111/tid.12894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- M.P. Cristelli
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - M.A. Mazolin
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - C. Manzardo
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - M.S.J. Ribeiro
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - F. Cofán
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - D.W.C. Santos
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - M.A. Castel
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - H. Tedesco-Silva
- Kidney Transplantation Division; Hospital do Rim, UNIFESP; São Paulo Brazil
| | - A. Moreno
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - F. Diekman
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
| | - J.M. Miro
- Hospital Clínic - IDIBAPS; University of Barcelona; Barcelona Spain
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36
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Abstract
Purpose of Review The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant. Recent Findings Clinical trials and registry-based studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with similar patient and graft survival as HIV-uninfected patients. Elevated allograft rejection rates have been observed in HIV+ individuals; this may be related to a dysregulated immune system or drug interactions. Lymphocyte-depleting immunosuppression has been associated with lower rejection rates without increased infections using national registry data. Hepatitis C virus (HCV) coinfection has been associated with worse outcomes, however improvements are expected with direct-acting antivirals. Summary Solid organ transplantation should be considered for HIV+ individuals with end-stage organ disease. Infectious disease clinicians can optimize ART to avoid pharmacoenhancers, which interact with immunosuppression. The timing of HCV treatment (pre- or post-transplant) should be discussed with the transplant team. Finally, organs from HIV+ donors can now be considered for HIV+ transplant candidates, within research protocols.
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Affiliation(s)
- Ashton A Shaffer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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37
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Terrault NA, McCaughan GW, Curry MP, Gane E, Fagiuoli S, Fung JYY, Agarwal K, Lilly L, Strasser SI, Brown KA. International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Candidates. Transplantation. 2017;101:945-955. [PMID: 28437387 DOI: 10.1097/tp.0000000000001708] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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38
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Terrault NA, Berenguer M, Strasser SI, Gadano A, Lilly L, Samuel D, Kwo PY, Agarwal K, Curry MP, Fagiuoli S. International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Recipients. Transplantation. 2017;101:956-967. [PMID: 28437388 DOI: 10.1097/tp.0000000000001704] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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39
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Rogers RL, Stock PG. Canadian Laws Are on Target-But Is the Transplant Community? Transplantation 2017; 101:682-3. [PMID: 28079761 DOI: 10.1097/TP.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Affiliation(s)
- Stefan Schlabe
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
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41
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Abstract
The number of women living with HIV continues to increase. Thirty years into the
AIDS epidemic, we now expect those with access to highly active antiretroviral
to survive into their seventh decade of life or beyond. Increasingly, the focus
of HIV care is evolving from preventing opportunistic infections and treating
AIDS-defining malignancies to strategies that promote longevity. This holistic
approach to care includes detection of malignancies that are associated with
certain viral infections, with chronic inflammation, and with lifestyle choices.
The decision to screen an HIV-infected women for cancer should include an
appreciation of the individualized risk of cancer, her life expectancy, and an
attempt to balance these concerns with the harms and benefits associated with
specific cancer screening tests and their potential outcome. Here, we review
cancer screening strategies for women living with HIV/AIDS with a focus on
cancers of the lung, breast, cervix, anus, and liver.
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Affiliation(s)
- David M Aboulafia
- 1 Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA, USA.,2 Division of Hematology, University of Washington, Seattle, WA, USA
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42
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Guaraldi G, Dolci G, Zona S, Tarantino G, Serra V, Ballarin R, Franceschini E, Codeluppi M, Brothers TD, Mussini C, Di Benedetto F. A frailty index predicts post-liver transplant morbidity and mortality in HIV-positive patients. AIDS Res Ther 2017; 14:37. [PMID: 28779758 PMCID: PMC5545092 DOI: 10.1186/s12981-017-0163-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We hypothesized that frailty acts as a measure of health outcomes in the context of LT. The aim of this study was to explore frailty index across LT, as a measure of morbidity and mortality. This was a retrospective observational study including all consecutive 47 HIV+patients who received LT in Modena, Italy from 2003 to June 2015. METHODS frailty index (FI) was constructed from 30 health variables. It was used both as a continuous score and as a categorical variable, defining 'most frail' a FI > 0.45. FI change across transplant (deltaFI, ΔFI) was calculated as the difference between year 1 FI (FI-Y1) and pre-transplant FI (FI-t0). The outcomes measures were mortality and "otpimal LT" (defined as being alive without multi-morbidity). RESULTS Median value of FI-t0 was 0.48 (IQR 0.42-0.52), FI-Y1 was 0.31 (IQR 0.26-0.41). At year five mortality rate was 45%, "optimal transplant" rate at year 1 was 38%. All the patients who died in the post-LT were most frail in the pre-LT. ΔFI was a predictor of mortality after correction for age and MELD (HR = 1.10, p = 0.006) and was inversely associated with optimal transplant after correction for age (HR = 1.04, p = 0.01). CONCLUSIONS We validated FI as a valuable health measure in HIV transplant. In particular, we found a relevant correlation between FI strata at baseline and mortality and a statistically significant correlation between, ΔFI and survival rate.
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43
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Agüero F, Forner A, Valdivieso A, Blanes M, Barcena R, Manzardo C, Rafecas A, Castells L, Abradelo M, Barrera-Baena P, González-Diéguez L, Salcedo M, Serrano T, Jiménez-Pérez M, Herrero JI, Gastaca M, Aguilera V, Fabregat J, Del Campo S, Bilbao I, Romero CJ, Moreno A, Rimola A, Miro JM. Human immunodeficiency virus-infected liver transplant recipients with incidental hepatocellular carcinoma: A prospective multicenter nationwide cohort study. Liver Transpl 2017; 23:645-651. [PMID: 28188668 DOI: 10.1002/lt.24741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/22/2016] [Indexed: 01/28/2023]
Abstract
There is a lack of data on incidental hepatocellular carcinoma (iHCC) in the setting of liver transplantation (LT) in human immunodeficiency virus (HIV)-infected patients. This study aims to describe the frequency, histopathological characteristics, and outcomes of HIV+ LT recipients with iHCC from a Spanish multicenter cohort in comparison with a matched cohort of LT patients without HIV infection. A total of 15 (6%) out of 271 patients with HIV infection who received LT in Spain from 2002 to 2012 and 38 (5%) out of the 811 HIV- counterparts presented iHCC in liver explants (P = 0.58). Patients with iHCC constitute the present study population. All patients also had hepatitis C virus (HCV)-related cirrhosis. There were no significant differences in histopathological features of iHCC between the 2 groups. Most patients showed a small number and size of tumoral nodules, and few patients had satellite nodules, microvascular invasion, or poorly differentiated tumors. After a median follow-up of 49 months, no patient developed hepatocellular carcinoma (HCC) recurrence after LT. HIV+ LT recipients tended to have lower survival than their HIV- counterparts at 1 (73% versus 92%), 3 (67% versus 84%), and 5 years (50% versus 80%; P = 0.06). There was also a trend to a higher frequency of HCV recurrence as a cause of death in the former (33% versus 10%; P = 0.097). In conclusion, among LT recipients for HCV-related cirrhosis, the incidence and histopathological features of iHCC in HIV+ and HIV- patients were similar. However, post-LT survival was lower in HIV+ patients probably because of a more aggressive HCV recurrence. Liver Transplantation 23 645-651 2017 AASLD.
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Affiliation(s)
- Fernando Agüero
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic- IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Andrés Valdivieso
- Hospital Universitario de Cruces-Universidad del País Vasco, Bilbao, Spain
| | | | | | | | - Antoni Rafecas
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Lluis Castells
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario Vall d`Hebrón, Barcelona, Spain
| | - Manuel Abradelo
- Servicio de Cirugía, Hospital Doce de Octubre, Madrid, Spain
| | - Pilar Barrera-Baena
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba, Córdoba, Spain
| | - Luisa González-Diéguez
- Liver Unit, Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Magdalena Salcedo
- Department of Liver Transplantation, Hospital General Gregorio Marañón, Madrid, Spain
| | - Trinidad Serrano
- Liver Unit, University Hospital Lozano Blesa-IIS Aragon, Zaragoza, Spain
| | - Miguel Jiménez-Pérez
- Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - José Ignacio Herrero
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mikel Gastaca
- Hospital Universitario de Cruces-Universidad del País Vasco, Bilbao, Spain
| | - Victoria Aguilera
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Hospital Universitario La Fe, Valencia, Spain
| | - Juan Fabregat
- Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | - Asunción Moreno
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Rimola
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.,Liver Unit, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José M Miro
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
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44
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Abstract
Mortality rates on the liver transplant waiting list are increasing. The shortage of organs has resulted in higher utilization of extended criteria donors (ECDs), with centers pushing the limits of what is acceptable for transplantation. Donor quality is more appropriately represented as a continuum of risk, and careful selection and matching of ECD grafts with recipients may lead to excellent outcomes. Although there is no precise definition for what constitutes an ECD liver, this review focuses on frequently cited characteristics, including donor age, steatosis, donation after cardiac death, and donors with increased risk of disease transmission.
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Affiliation(s)
- Irine Vodkin
- Division of Gastroenterology and Hepatology, University of California, San Diego, 200 West Arbor Drive M/C 8413, San Diego, CA, USA.
| | - Alexander Kuo
- Division of Gastroenterology and Hepatology, University of California, San Diego, 200 West Arbor Drive M/C 8413, San Diego, CA, USA
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45
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Abstract
The prevention, diagnosis, and management of infectious disease in transplantation are major contributors to improved outcomes in organ transplantation. The risk of serious infections in organ recipients is determined by interactions between the patient's epidemiological exposures and net state of immune suppression. In organ recipients, there is a significant incidence of drug toxicity and a propensity for drug interactions with immunosuppressive agents used to maintain graft function. Thus, every effort must be made to establish specific microbiologic diagnoses to optimize therapy. A timeline can be created to develop a differential diagnosis of infection in transplantation based on common patterns of infectious exposures, immunosuppressive management, and antimicrobial prophylaxis. Application of quantitative molecular microbial assays and advanced antimicrobial therapies have advanced care. Pathogen-specific immunity, genetic polymorphisms in immune responses, and dynamic interactions between the microbiome and the risk of infection are beginning to be explored. The role of infection in the stimulation of alloimmune responses awaits further definition. Major hurdles include the shifting worldwide epidemiology of infections, increasing antimicrobial resistance, suboptimal assays for the microbiologic screening of organ donors, and virus-associated malignancies. Transplant infectious disease remains a key to the clinical and scientific investigation of organ transplantation.
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Affiliation(s)
- J A Fishman
- Transplant Infectious Disease and Immunocompromised Host Program and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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46
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Warren-Gash C, Childs K, Thornton A, Bhagani S, Demma S, Srivastava A, Leen C, Agarwal K, Rodger AJ, Sabin CA. Cirrhosis and liver transplantation in patients co-infected with HIV and hepatitis B or C: an observational cohort study. Infection 2017; 45:215-220. [PMID: 28054251 PMCID: PMC5374166 DOI: 10.1007/s15010-016-0976-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022]
Abstract
This study assessed the likelihood of referral for liver transplantation assessment in a prospective cohort of patients co-infected with HIV and hepatitis B or C with complications of cirrhosis. There were 141 co-infected patients from 11 UK centres with at least one complication of cirrhosis recorded (either decompensation or hepatocellular carcinoma) out of 772 identified with cirrhosis and/or HCC. Only 23 of these 141 (16.3%) were referred for liver transplantation assessment, even though referral is recommended for co-infected patients after the first decompensation episode.
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Affiliation(s)
- Charlotte Warren-Gash
- Institute of Health Informatics, University College London, London, UK.
- The Farr Institute of Health Informatics Research, 222 Euston Road, London, NW1 2DA, UK.
| | - Kate Childs
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Alicia Thornton
- Research Department of Infection and Population Health, University College London, London, UK
| | - Sanjay Bhagani
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Shirin Demma
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
- Hepatology Unit, Department of Experimental and Clinical Medicine, University of Catania, Catania, Italy
| | - Ankur Srivastava
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Clifford Leen
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Caroline A Sabin
- Research Department of Infection and Population Health, University College London, London, UK
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47
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Castells L, Llaneras J, Campos-Varela I, Bilbao I, Crespo M, Len O, Rodríguez-Frías F, Charco R, Salcedo T, Esteban JI, Esteban-Mur R. Sofosbuvir and daclatasvir in mono- and HIV-coinfected patients with recurrent hepatitis C after liver transplant. Ann Hepatol 2017; 16:86-93. [PMID: 28051797 DOI: 10.5604/16652681.1226819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Background and aims. Pegylated interferon (Peg-INF) and ribavirin (RBV) based therapy is suboptimal and poorly tolerated. We evaluated the safety, tolerability and efficacy of a 24-week course of sofosbuvir plus daclatasvir without ribavirin for the treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) in both HCV-monoinfected and human immunodeficiency virus (HIV)-HCV coinfected patients. MATERIAL AND METHODS We retrospectively evaluated 22 consecutive adult LT recipients (16 monoinfected and 6 coinfected with HIV) who received a 24-week course of sofosbuvir plus daclatasvir treatment under an international compassionate access program. RESULTS Most patients were male (86%), with a median age of 58 years (r:58-81y). Median time from LT to treatment onset was 70 months (r: 20-116 m). HCV genotype 1b was the most frequent (45%), 55% had not responded to previous treatment with Peg-INF and RBV and 14% to regiments including first generation protease inhibitors. Fifty-six percent of the patients had histologically proven cirrhosis and 6 had ascites at baseline. All patients completed the 24-week treatment course without significant side effects except for one episode of severe bradicardya, with only minor adjustments in immunosuppressive treatment in some cases. Viral suppression was very rapid with undetectable HCV-RNA in all patients at 12 weeks. All 22 patients achieved a sustained virological response 12 weeks after treatment completion. CONCLUSION The combination of sofosbuvir plus daclatasvir without ribavirin is a safe and effective treatment of HCV recurrence after LT in both monoinfected and HIV-coinfected patients, including those with decompensated cirrhosis.
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Affiliation(s)
- Lluís Castells
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Jordi Llaneras
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID); Department of Internal Medicine, Hospital of Santiago de Compostela. Santiago de Compostela, Spain
| | - Itxarone Bilbao
- Liver Transplant Unit, Department of HPB-Surgery and Transplant, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Manel Crespo
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Oscar Len
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramon Charco
- Liver Transplant Unit, Department of HPB-Surgery and Transplant, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Teresa Salcedo
- Pathology Department. Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona. Spain
| | - Juan Ignacio Esteban
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Rafael Esteban-Mur
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
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48
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Roll GR, Stock PG. Strategies to improve outcomes for hepatitis C virus/human immunodeficiency virus coinfected liver transplant candidates. Liver Transpl 2016; 22:1181-2. [PMID: 27386826 DOI: 10.1002/lt.24512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Garrett R Roll
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Peter G Stock
- Department of Surgery, University of California San Francisco, San Francisco, CA
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49
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Araiz JJ, Serrano MT, García-Gil FA, Lacruz EM, Lorente S, Sánchez JI, Suarez MA. Intention-to-treat survival analysis of hepatitis C virus/human immunodeficiency virus coinfected liver transplant: Is it the waiting list? Liver Transpl 2016; 22:1186-96. [PMID: 27114030 DOI: 10.1002/lt.24474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 04/08/2016] [Indexed: 01/13/2023]
Abstract
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. Liver Transplantation 22 1186-1196 2016 AASLD.
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Affiliation(s)
- Juan J Araiz
- Transplant Procurement Management, University Hospital Lozano Blesa, Zaragoza, Spain.,Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain
| | - M Trinidad Serrano
- Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain.,Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Francisco A García-Gil
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Hepatic Surgery Unit, Department of Surgery, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Surgery, University of Zaragoza, Zaragoza, Spain
| | - Elena M Lacruz
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Sara Lorente
- Liver Unit, Department of Gastroenterology, University Hospital Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - José I Sánchez
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Miguel A Suarez
- Intensive Care Unit, University Hospital Lozano Blesa, Zaragoza, Spain.,Department of Medicine, University Hospital Lozano Blesa, Zaragoza, Spain
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50
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Campos-Varela I, Dodge JL, Stock PG, Terrault NA. Key donor factors associated with graft loss among liver transplant recipients with human immunodeficiency virus. Clin Transplant 2016; 30:1140-5. [PMID: 27411037 DOI: 10.1111/ctr.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected liver transplant (LT) recipients have higher risk of graft loss than HIV-uninfected recipients. As the original donor risk index excluded HIV-positive patients, donor factors associated with graft loss in HIV-positive recipients are unknown. METHODS Identifying all HIV-positive patients in the Scientific Registry of Transplant Recipients, supplemented by all HIV-infected patients in the solid organ transplantation in HIV: Multi-Site Study (HIV-TR), we evaluated donor factors associated with graft loss among HIV-positive recipients transplanted between March 2002 and August 2012. RESULTS A total of 249 HIV-positive LT recipients were followed for median 2.4 (interquartile range [IQR]: 0.8-4.9) years. In univariate analysis, donor diabetes (HR=2.09; P=.002) and donor hypertension (HR=1.43; P=.048) were significantly associated with graft loss, and African-American (AA) recipient:non-AA donor race mismatch (HR=1.60; P=.07), other cause of donor death compared to trauma (HR=2.02; P=.09), and donor age 30 years or older (HR=1.53; P=.05) were of borderline significance. In multivariate analysis, donor diabetes (HR=2.12; 95% CI: 1.33-3.38; P=.002) was the only significant predictor of graft loss. CONCLUSION In HIV-positive LT recipients, risk of graft loss is strongly influenced by donor diabetes. This information may be useful to transplant physicians seeking to optimize overall graft survival in their HIV-positive LT recipients.
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Affiliation(s)
- Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID), Santiago de Compostela, Spain.,Department of Internal Medicine, Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jennifer L Dodge
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Peter G Stock
- Department of Surgery, University of California-San Francisco, San Francisco, CA, USA
| | - Norah A Terrault
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA. .,Department of Surgery, University of California-San Francisco, San Francisco, CA, USA.
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