Surgical Complications in 275 Human Immunodeficiency Virus (HIV) Infected Liver and/or Kidney Transplant Recipients

• Authors: J. Harbell, University of California; J. Fung, Cleveland Clinic; N. Nissen, Cedars Sinai; K. Olthoff, University of Pennsylvania; S. S. Florman, Mt. Sinai Medical Center; D. W. Hanto, Beth Israel Deaconess Medical Center; J. Light, Washington Hospital Center; S. T. Bartlett, University of Maryland Medical Center; A. G. Tzakis, University of Miami; Thomas C Pearson, Emory University; B. Barin, The EMMES Corporation; M. E. Roland, University of California; P. G. Stock, University of California
• Journal Title: Journal of Surgical Research
• Volume: Volume 152, Number 3
• Publisher: Elsevier | 2012-09-01, Pages 376-381
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jss.2011.11.206
• Subjects: Biology, Virology; Health Sciences, Immunology; Biology, Microbiology

Abstract

Background: This report examines the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplant (TX) recipients in a prospective non-randomized US multicenter trial. Methods: Subjects required CD4+ T-cell count > 200/100 cells/mm3 (K/L) & undetectable plasma HIV-1 RNA (VL) (K) or expected post-transplant suppression (L). Impact of SCs (N≥7) was evaluated using proportional hazards (PH) models. Baseline morbidity predictors for SCs (N≥7) were assessed in univariate PH models. Results: At median 2.7 [interquartile range (IQR) 1.9, 4.1] & 2.3 [1.0, 3.7] years post- TX, 3-month & 1-year graft survival were [K] 96% (CI 91%,98%) & 91% (85%,94%) & [L] 91% (85%,95%) & 77% (69%,84%). 14K and 28L graft losses occurred in the first year; 6K and 11L were in the first 3 months. 26(17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (HR: 2.8; 95% CI: 1.0-8.4; p=0.06) with increased risk of graft loss, while higher MELD pre-transplant (HR: 1.07 per point increase; 95% CI: 1.01-1.14; p=0.02), and detectable viral load pre-TX (HR: 3.6; 95% CI: 0.9-14.6; p=0.07) was associated with an increased risk of wound infections/dehiscence. Conclusions: The rates and outcomes of surgical complications are similar to what has been observed in the non-HIV setting in carefully selected HIV-infected liver and kidney TX recipients.