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Dropout rate for liver transplant elevated in patients with HIV
Vibert E. Hepatology. 2011;53:475-482.
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Predicting the risk for dropout and determining patients who may develop hepatocellular carcinoma recurrence after liver transplant are significant clinical goals in patients who are HIV-positive, according to René Adam, MD, PhD, and colleagues.
“Liver transplant is the optimum treatment for hepatocellular carcinoma and can also be considered for controlled HIV-positive patients with liver cancer,” Adam, president of the medical board, Paul Brousse Hospital in Villejuif, France, and head of the oncological surgery unit at its hepatobiliary center, said in a news release. “Our study showed that HIV-infection impaired the results of liver transplantation on an intent-to-treat basis, but exerted no significant impact on overall survival and recurrence-free survival following transplantation.”
Adam and colleagues set out to assess the effect of liver transplantation for hepatocellular carcinoma in patients with and without HIV. The study cohort included 21 HIV-positive patients and 65 HIV-negative patients with hepatocellular carcinoma scheduled for a liver transplant between 2003 and 2008 at a single institution in France.
Highly active antiretroviral therapy was initiated in all HIV-positive patients before being placed on the transplant list; no AIDS-related event or opportunistic infections were recorded.
Compared with a dropout rate of 10% for HIV-negative patients, 23% of those who were HIV-positive dropped out of the transplant waiting list.
Moreover, significantly higher alpha-fetoprotein levels were observed at the time of listing in those with HIV who dropped out (98 mcg/L) vs. those who received a liver transplant (12 mcg/L). One HIV-positive patient dropped out due to progression from HIV to AIDS, according to the researchers.
“Our study confirmed the importance of this preoperative factor (alpha-fetoprotein levels), as all HIV-positive patients who dropped out displayed a rise in [alpha-fetoprotein] levels,” Adam said. “There is clearly a critical need for more effective neoadjuvant therapy in HIV-positive patients with hepatocellular carcinoma; however, there are no objective arguments to contraindicate liver transplantation in this group if strict criteria are used for selection and patients are closely monitored until surgery.”
Disclosure: The researchers report no relevant financial disclosures.
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