TY - JOUR
T1 - MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates
AU - Subramanian, Aruna
AU - Sulkowski, Mark
AU - Barin, Burc
AU - Stablein, Donald
AU - Curry, Michael
AU - Nissen, Nicholas
AU - Dove, Lorna
AU - Roland, Michelle
AU - Florman, Sander
AU - Blumberg, Emily
AU - Stosor, Valentina
AU - Jayaweera, D. T.
AU - Huprikar, Shirish
AU - Fung, John
AU - Pruett, Timothy
AU - Stock, Peter
AU - Ragni, Margaret
N1 - Funding Information:
Funding Supported by NIAID Grant U01 A1052748 (to P.S.) and R01 DA016065 (to M.S.S.). On behalf of Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) Investigators.
PY - 2010/1
Y1 - 2010/1
N2 - Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.
AB - Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.
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U2 - 10.1053/j.gastro.2009.09.053
DO - 10.1053/j.gastro.2009.09.053
M3 - Article
C2 - 19800334
AN - SCOPUS:72549096099
SN - 0016-5085
VL - 138
SP - 159
EP - 164
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -
