Changing Landscape of Liver Transplantation in the Post-DAA and Contemporary ART Era

Huma Saeed, Edison J. Cano, Mohammad Qasim Khan, Zachary A. Yetmar, Byron Smith, Stacey A. Rizza, Andrew D. Badley, Maryam Mahmood, Michael D. Leise, Nathan W. Cummins

Research output: Contribution to journalArticlepeer-review

Abstract

Combination anti-retroviral therapy has drastically improved solid organ transplantation outcomes in persons living with HIV. DAA therapy has led to the successful eradication of HCV. While recent data have suggested improvement in outcomes in HIV/HCV-coinfected liver transplant recipients, temporal trends in patient survival within pre- and post-DAA eras are yet to be elucidated. The UNOS database was utilized to identify deceased donor liver transplant recipients between 1 January 2000 and 30 September 2020 and stratify them by HIV and HCV infection status. A total of 85,730 patients met the inclusion criteria. One-year and five-year patient survival improved (93% and 80%, respectively) for all transplants performed post-2015. For HIV/HCV-coinfected recipients, survival improved significantly from 78% (pre-2015) to 92% (post-2015). Multivariate regression analyses identified advanced recipient age, Black race, diabetes mellitus and decompensated cirrhosis as risk factors associated with higher one-year mortality. Liver transplant outcomes in HIV/HCV-coinfected liver transplant recipients have significantly improved over the last quinquennium in the setting of the highly effective combination of ART and DAA therapy. The presence of HIV, HCV, HIV/HCV-coinfection and active HCV viremia at the time of transplant do not cause higher mortality risk in liver transplant recipients in the current era.

Original languageEnglish (US)
Article number1755
JournalLife
Volume12
Issue number11
DOIs
StatePublished - Nov 2022

Keywords

  • HIV/AIDS
  • anti-retroviral therapy
  • direct-acting antiviral therapy
  • hepatitis C virus
  • liver transplantation

ASJC Scopus subject areas

  • Ecology, Evolution, Behavior and Systematics
  • Biochemistry, Genetics and Molecular Biology(all)
  • Space and Planetary Science
  • Palaeontology

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