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Liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection
Author(s) -
Vibert Eric,
DuclosVallée JeanCharles,
Ghigna MariaRosa,
Hoti Emir,
Salloum Chady,
Guettier Catherine,
Castaing Denis,
Samuel Didier,
Adam René
Publication year - 2011
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24062
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , liver transplantation , transplantation , human immunodeficiency virus (hiv) , univariate analysis , liver disease , stage (stratigraphy) , carcinoma , surgery , multivariate analysis , immunology , biology , paleontology
Liver transplantation (LT) has become an accepted therapy for end‐stage liver disease in human immunodeficiency virus–positive (HIV+) patients, but the specific results of LT for hepatocellular carcinoma (HCC) are unknown. Between 2003 and 2008, 21 HIV+ patients and 65 HIV− patients with HCC were listed for LT at a single institution. Patient characteristics and pathological features were analyzed. Univariate analysis for overall survival (OS) and recurrence‐free survival (RFS) after LT was applied to identify the impact of HIV infection. HIV+ patients were younger than HIV− patients [median age: 48 (range = 41‐63 years) versus 57 years (range = 37‐72 years), P < 0.001] and had a higher alpha‐fetoprotein (AFP) level [median AFP level: 16 (range = 3‐7154 μg/L] versus 13 μg/L (range = 1‐552 μg/L), P = 0.04]. There was a trend toward a higher dropout rate among HIV+ patients (5/21, 23%) versus HIV− patients (7/65, 10%, P = 0.08). Sixteen HIV+ patients and 58 HIV− patients underwent transplantation after median waiting times of 3.5 (range = 0.5‐26 months) and 2.0 months (range = 0.5‐24 months, P = 0.18), respectively. No significant difference was observed in the pathological features of HCC. With median follow‐up times of 27 (range = 5‐74 months) and 36 months (range = 3‐82 months, P = 0.40), OS after LT at 1 and 3 years reached 81% and 74% in HIV+ patients and 93% and 85% in HIV− patients, respectively ( P = 0.08). RFS rates at 1 and 3 years were 69% and 69% in HIV+ patients and 89% and 84% in HIV− patients, respectively ( P = 0.09). In univariate analysis, HIV status did not emerge as a prognostic factor for OS or RFS. Conclusion: Because of a higher dropout rate among HIV+ patients, HIV infection impaired the results of LT for HCC on an intent‐to‐treat basis but had no significant impact on OS and RFS after LT. (H EPATOLOGY 2011;53:475‐482)