Treatment News : Survival Benefit Among HIV-Positive Liver, Kidney Transplant Recipients - by Tim Horn

POZ - Health, Life and HIV
Subscribe to:
POZ magazine
Newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:

Back to home » Treatment News » July 2011

Most Popular Links
Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

15 Years Ago In POZ


More Treatment News

Click here for more news

Have news about HIV? Send press releases, news tips and other announcements to news@poz.com.


emailprint

July 18, 2011

Survival Benefit Among HIV-Positive Liver, Kidney Transplant Recipients

by Tim Horn

Survival is “excellent” among people living with HIV undergoing kidney transplants, according to a new analysis presented by researchers associated with the Solid Organ Transplantation in HIV Study at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention on Monday, July 18, in Rome. The study authors also note a clear survival advantage among people living with HIV undergoing liver transplants, but also made clear that certain pre-transplant risk factors—such as hepatitis C virus (HCV) coinfection, low body mass index and low Model for End-Stage Liver Disease (MELD) scores—may negative affect survival and increase the risk for serious post-surgery complications.

Historically, people with end-stage organ disease were excluded from organ transplant lists—lists that are tightly guarded to begin with—if they had HIV. This is because experts once believed that the organs should go to people with better chances of survival.

In the late 1990s, however—with the introduction of potent combination antiretroviral (ARV) therapy—survival for people living with HIV increased substantially, effectively ending arguments that they were less likely to live than their HIV-negative counterparts. And as end-organ disease continues to be a major cause of illness and death among people living with the virus, the need for organs—from both live and cadaveric donors—is high.

According to George Beatty, MD, MPH, of the University of California at San Francisco, and his colleagues, the limited experience with liver and kidney transplants since combination ARV therapy was introduced has been encouraging. Yet the optimal selection criteria—determining which people living with HIV will benefit most from transplants—and predictors of outcomes remain undefined.

Beatty’s group set out to describe both rates and predictors of patient survival, AIDS-related opportunistic infections and cancers, and other serious infections requiring hospitalization among 125 HIV-positive liver transplant recipients and 150 HIV-positive kidney transplant recipients.

Kidney recipients were followed in the study for an average of 2.3 years; liver transplant recipients were followed for an average of 2.7 years.

One year after transplant surgery, 95 percent of the kidney recipients and 80 percent of the liver recipients were still alive. Three years after transplant surgery, survival rates were 91 and 67 percent, respectively.

The factors associated with death among kidney recipients were hepatitis C virus (HCV) coinfection and, to a lesser extent, age. The need for thymoglobulin—a drug used to treatment kidney transplant rejection—was also suggested to be a factor associated with death, but these finding was not statistically significant.

As for liver transplant recipients, factors shown to be associated with an increased risk of death during the follow-up period were dual-organ transplant—individuals who received both a kidney and liver, for example—a pre-transplant body mass index below 21, and receiving a liver from a donor older than 40. Factors that were marginally associated with mortality were HCV infection and a detectable HIV viral load before transplant surgery.

Beatty and his colleagues also reported that the clearest survival benefit after liver transplantation was among those with high MELD scores—those with the most advanced end-stage liver disease. For those with lower MELD scores, signaling less advanced end-stage liver disease, survival rates were no better compared to those in the study who were on waiting lists but had not had a transplant. Though AIDS-related opportunistic infections (OIs) and cancers were documented in patients both before and after transplant surgery, Beatty’s group noted that there were no recurrences in patients with OI histories, despite the use of immune-suppressing drugs to prevent organ rejection. He also noted no survival differences based on OI history.

There were many serious infections that either required hospitalization or occurred while patients were hospitalized following transplant surgery, Beatty noted. About half the liver-transplant and kidney-transplant recipients required hospitalization for a variety of bacterial, fungal, viral and protozoal infections.

Factors associated with initial serious infection, among kidney recipients, were HCV coinfection, thymoglobulin use and lowest-ever CD4 count. Among liver recipients, HCV coinfection, the length of time the CD4 count remained compromised and white race were factors associated with initial serious infection.

In conclusion, Beatty noted, “Kidney survival is excellent, and liver transplant in high MELD confers survival.” As for pre-transplant factors to consider among people living with HIV, he noted that body mass index, HCV infection and the need for dual organ transplants—but nothing specific to HIV or its treatment—may influence recommendations regarding selection criteria in liver candidates.

Search: transplant, liver, kidney, survival, UCSF, Beatty, MELD, IAS, Rome


Scroll down to comment on this story.



Name:

(will display; 2-50 characters)

Email:

(will NOT display)

City:

(will display; optional)

Comment (500 characters left):

(Note: The POZ team reviews all comments before they are posted. Please do not include either ":" or "@" in your comment. The opinions expressed by people providing comments are theirs alone. They do not necessarily reflect the opinions of Smart + Strong, which is not responsible for the accuracy of any of the information supplied by people providing comments.)

Comments require captcha.
Please enter this number for verification:

| Posting Rules



Hide comments

Previous Comments:


         


[Go to top]


Facebook Twitter Google+ MySpace YouTube Tumblr Flickr Instagram
Quick Links
Current Issue

HIV Testing
Safer Sex
Find a Date
Newly Diagnosed
HIV 101
Disclosing Your Status
Starting Treatment
Help Paying for Meds
Search for the Cure
POZ Stories
POZ Opinion
POZ Exclusives
Read the Blogs
Visit the Forums
Job Listings
Events Calendar
POZ on Twitter

Ask POZ Pharmacist

Talk to Us
Poll
Have you ever been diagnosed with diabetes or pre-diabetes?
Yes
No

Survey
Pop Watch

more surveys
Contact Us
We welcome your comments!
[ about Smart + Strong | about POZ | POZ advisory board | partner links | advertising policy | advertise/contact us | site map]
© 2014 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.