Graft, patient survival improves in HIV, HCC liver transplant recipients
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.