Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients

Jack Harbell, John Fung, Nicholas Nissen, Kim Olthoff, Sander S. Florman, Douglas W. Hanto, Jimmy Light, Steve T. Bartlett, Andreas G. Tzakis, Thomas C. Pearson, Burc Barin, Michelle E. Roland, Peter G. Stock

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20 Scopus citations

Abstract

Background: In this report, we examine the surgical safety and complications (SC) among 125 liver (L) and 150 kidney (K) HIV+ transplantation (TX) recipients in a prospective nonrandomized U.S. multicenter trial. Methods: Subjects were required to have CD4 + T-cell counts >200/100 cells/mm 3 (K/L) and undetectable plasma HIV-1 RNA (Viral Load [VL]) (K) or expected posttransplantation suppression (L). Impact of SCs (N ≥ 7) was evaluated by use of the proportional hazards models. Baseline morbidity predictors for SCs (N ≥ 7) were assessed in univariate proportional hazards models. Results: At median 2.7 (interquartile range 1.9-4.1) and 2.3 (1.0-3.7) years after TX, 3-month and 1-year graft survival were [K] 96% (95% CI 91%-98%) and 91% (95% CI 85%-94%) and [L] 91% (95% CI 85%-95%) and 77% (95% CI 69%-84%), respectively. A total of 14 K and 28 L graft losses occurred in the first year; 6 K and 11 L were in the first 3 months. A total of 26 (17%) K and 43 (34%) L experienced 29 and 62 SCs, respectively. In the liver multivariate model, re-exploration was marginally associated (hazard ratio [HR] 2.8; 95% CI 1.0-8.4; P =.06) with increased risk of graft loss, whereas a greater MELD score before transplantation (HR 1.07 per point increase; 95% CI: 1.01-1.14; P =.02), and detectable viral load before TX (HR 3.6; 95% CI 0.9-14.6; P =.07) was associated with an increased risk of wound infections/dehiscence. Conclusion: 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.

Original languageEnglish
Pages (from-to)376-381
Number of pages6
JournalSurgery (United States)
Volume152
Issue number3
DOIs
StatePublished - Sep 2012

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