Graft, patient survival improves in HIV, HCC liver transplant recipients
Click Here to Manage Email Alerts
Outcomes have improved significantly among HIV/Hepatitis C virus-coinfected liver transplant recipients in the direct-acting antiviral era, according to data presented at the Digestive Disease Week.
“The practice of liver transplant for HIV-positive patients has been increasing since 2013 when the HOPE Act was passed; however, the number is still low, less than 1% of total liver transplants,” Jennifer Wang, from the University of Chicago, said during her presentation. “There is a significant geographic variation of HIV/HCV coinfected liver transplant practice with limited number of participating centers. Liver transplant outcomes for coinfected patients have improved significantly in the [direct-acting antiviral (DAA)] era and are comparable to patients without either infection.”
Wang and colleagues analyzed data from the Organ Procurement and Transplantation Network (OPTN) on adult patients in the United States who underwent liver transplantation between 2008 and 2019. They identified 70,125 liver transplant patients, 416 of whom were HIV-infected.
Investigators compared outcomes among three groups: liver transplant recipients with HIV/HCV-coinfection in the DAA era (Jan. 1, 2014 – Dec. 31, 2019), recipients without coinfection but with either HIV-monoinfection or HCV-monoinfection in the DAA era and recipients with coinfection in the pre-DAA era (Jan. 1. 2008 - Dec. 31, 2012).
Study data showed that over time, the practice of liver transplantation had increasing from 28 patients in 2014 to 64 patients in 2019, with 23 patients having HIV/HCV co-infection. Investigators report the HIV/HCV coinfected liver transplant recipients in the DAA era compared with their counterparts in the pre-DAA era were older, (median, 57 vs. 54 years), had longer median waitlist times (231 vs. 99 days) and received more HIV nucleic acid testing-positive organs (10% vs. 0%; P < .05).
Wang said co-infected liver transplant recipients in the DAA era had a 1-year cumulative graft survival rate of 88.6% and 81.7% at 3 years, compared with 76.3% and 58% in the pre-DAA era (P = .006). However, there was no statistical differences in graft survival when researchers compared it to other groups in the DAA era.
“There was no difference in graft failure outcomes in the HIV/HCV coinfected group compared to the uninfected group in the DAA era (HR = 1.24;, 95% CI = 0.81-1.89),” Wang said.
According to results from a Cox proportional hazards model limited to only 271 HIV liver transplant recipients in the DAA era, HCV infection was not correlated with graft failure (adjusted HR = 1; 95% CI, 0.53-1.89). Among coinfected liver transplant recipients in the DAA era, the presence of HCC was not correlated with graft failure (aHR = 0.71; 95% CI, 0.28-1.75).
“Highly potent DAA should change how we view HIV/HCV coinfected patients in the setting of liver transplants as the presence of HCV no longer pertains to worse outcomes,” Wang concluded.
Perspective
Back to Top
This study was very encouraging in that we have now evolved from when transplantation of those who are HIV positive was a rare event with less-than-optimal outcomes, to the point where liver transplant outcomes for those with HIV and hepatitis C since the DAA era are comparable to patients without either infection. This really reflects the advances we've made in the treatment of HIV and hepatitis C.
Wang and colleagues looked at transplants that occurred in multiple groups: HIV/hepatitis C coinfection during the DAA era, HIV monoinfection or HCV monoinfection during the DAA era, and recipients with coinfection who were transplanted prior to the DAA era. In addition to an increase in volume of transplants for coinfection, they also noted that the HIV/hepatitis C coinfected group transplanted in the DAA era were older, waited longer for transplant and received more HIV positive organs. However, the survival rate was 89% at 1 year and 82% at 3 years and this was substantially better than survival rates that were seen prior to introduction of DAAs in 2012.
More importantly, when they looked at other outcomes in HIV/hepatitis C now, there's no difference in graft failure outcomes compared with uninfected individuals during the DAA era, this tells us that the DAA therapies, in addition to markedly improving the survival in those who are monoinfected with hepatitis C, have now also changed the outlook for those who are HIV/hepatitis C coinfected as well. As these individuals present for consideration for transplantation, we should move forward recognizing that we have the tools to continue to suppress HIV as well as successfully treat hepatitis C. If transplantation is required, we should be confident that their outcomes will not be different than those who don't have either of these infections.
DAA therapies have changed the landscape of transplantation, and we should continue to screen, diagnose and link to care for hepatitis C and HIV infected individuals to get their hepatitis C successfully treated and HIV suppressed so that these individuals don't require transplant evaluation or listing for transplant.
Collapse
Wang J, et al. Abstract 172. Presented at: Digestive Disease Week; May 21-24, 2021 (virtual meeting).
Read more about
Click Here to Manage Email Alerts