背景:高效抗逆转录病毒疗法(HAART)已经能够改善人类免疫缺陷病毒(HIV)患者的免疫系统功能和存活率。然而,合并感染HIV和乙型肝炎病毒(HBV)的患者比单独感染HBV的患者更有可能发展为终末期肝病(ESLD)。因此,这些患者通常需要肝移植。本研究评估了中国HIV-HBV合并感染患者的原位肝移植(OLT)的结果。
方法:我们对2019年4月1日至2021年12月31日接受OLT的所有HIV-HBV合并感染患者进行了回顾性分析,并将其结果与同期接受OLT的所有HBV单感染患者进行了比较。确定患者结果,包括累积生存率,病毒载量,CD4T细胞计数与术后并发症。
结果:HIV接受者的中位随访时间为OLT后36个月(四分位距12-39个月)。几乎所有患者都有稳定的CD4T细胞计数(>200拷贝/ul),无法检测的HBVDNA水平,和在随访期间检测不到的HIVRNA负荷。1-,2-,HIV组的移植后3年生存率为85.7%(1至3年不变),而不是82.2%,81.2%,非HIV组的78.8%。HIV-HBV合并感染的接受者的累积生存率与HBV单感染的接受者没有显着差异(对数秩检验P=0.692)。艾滋病毒组和非艾滋病毒组之间因感染而死亡的百分比相当(14.3%vs.9.32%,P=0.665)。后OLT,急性排斥反应没有显着差异,巨细胞病毒感染,菌血症,肺部感染,急性肾损伤,从头肿瘤和血管和胆道并发症。
结论:在中国,HIV-HBV合并感染患者的肝移植在中期或长期生存率和术后并发症发生率方面取得了优异的结果。这些发现表明,OLT对于HIV-HBV合并感染的ESLD患者是安全可行的。
背景:中国临床试验注册中心(ChiCTR2300067631),2023年1月11日登记。
BACKGROUND: Highly active antiretroviral therapy (HAART) has been able to improve the immune system function and survival of human immunodeficiency virus (HIV) patients. However, Patients coinfected with HIV and hepatitis B virus (HBV) are more likely to develop end-stage liver disease (ESLD) than those infected with HBV alone. Consequently, liver transplantation is often required for these patients. This study evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-HBV coinfected patients in
China.
METHODS: We conducted a retrospective analysis on all HIV-HBV coinfected patients that underwent OLT from April 1, 2019 to December 31, 2021 and their outcomes were compared to all HBV monoinfected patients undergoing OLT during the same period. Patient outcomes were determined, including cumulative survival, viral load, CD4 T-cell count and postoperative complications.
RESULTS: The median follow-up of HIV recipients was 36 months after OLT (interquartile range 12-39 months). Almost all patients had stable CD4 T-cell count (> 200 copies/ul), undetectable HBV DNA levels, and undetectable HIV RNA load during follow-up. The 1-, 2-, and 3-year posttransplant survival rates were 85.7% for the HIV group (unchanged from 1 to 3 years) versus 82.2%, 81.2%, and 78.8% for the non-HIV group. Cumulative survival among HIV-HBV coinfected recipients was not significantly different from the HBV monoinfected recipients (log-rank test P = 0.692). The percentage of deaths attributed to infection was comparable between the HIV and non-HIV groups (14.3% vs. 9.32%, P = 0.665). Post OLT, there was no significant difference in acute rejection, cytomegalovirus infection, bacteremia, pulmonary infection, acute kidney injury, de novo tumor and vascular and biliary complications.
CONCLUSIONS: Liver transplantation in patients with HIV-HBV coinfection yields excellent outcomes in terms of intermediate- or long-term survival rate and low incidence of postoperative complications in
China. These findings suggest that OLT is safe and feasible for HIV-HBV coinfected patients with ESLD.
BACKGROUND: Chinese Clinical Trial Registry (ChiCTR2300067631), registered 11 January 2023.