Liver Retransplantation in Patients With HIV-1 Infection: An International Multicenter Cohort Study

• Autor(a) principal: Agüero, F
• Data de Publicação: 2016
• Outros Autores: Rimola, A, Stock, P, Grossi, P, Rockstroh, JK, Agarwal, K, Garzoni, C, Barcan, LA, Maltez, F, Manzardo, C, Mari, M, Ragni, MV, Anadol, E, Di Benedetto, F, Nishida, S, Gastaca, M, Miró, JM
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/2731
• topic: Adult; Cohort Studies; Coinfection; Female; Follow-Up Studies; Graft Survival; HIV Infections; HIV-1; Hepacivirus; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; International Agencies; Male; Middle Aged; Prognosis; Reoperation; Risk Factors; Survival Rate; Liver Transplantation; Postoperative Complications; HCC INF

Liver retransplantation is performed in HIV-infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV-infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV-infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents.