Survival of Human Immunodeficiency Virus–Infected Liver Transplant Recipients

Abstract

Human immunodeficiency virus (HIV) infection has been considered an absolute contraindication to solid-organ transplantation. With immune function restoration possible with highly active antiretroviral therapy (HAART), we evaluated 24 HIV-positive subjects with end-stage liver disease who were undergoing orthotopic liver transplantation (OLTX) after the availability of HAART. The cumulative survival among HIV-positive recipients was similar to that among age- and race-comparable HIV-negative recipients (P=.365, by log-rank test). At 12, 24, and 36 months after OLTX, survival was, respectively, 87.1%, 72.8%, and 72.8% among HIV-positive patients, versus 86.6%, 81.6%, and 77.9% among HIV-negative patients. Survival was poorer among subjects with post-OLTX antiretroviral intolerance (P=.044), a post-OLTX CD4(+) cell count of <200 cells/microL (P=.005), a post-OLTX HIV load of >400 copies/mL (P=.016), and hepatitis C virus infection (P=.023). These findings suggest that survival of HIV-positive liver transplant recipients does not differ from that of HIV-negative liver transplant recipients, and they suggest that HIV infection should no longer be a contraindication to OLTX. Further prospective studies are warranted.