Combined Hepatitic/Cholangiopathic Lesion in HIV-HCV Co-Infected Liver Transplant Recipients Associated With Graft Loss
1Surgery, University of California, San Francisco, San Francisco, CA
2Pathology, University of California, San Francisco, San Francisco, CA
3EMMES Corporation, Rockville, MD.
Meeting: 2015 American Transplant Congress
Abstract number: A189
Keywords: Hepatitis B, Hepatitis C, HIV virus, Liver transplantation
Session Information
Session Name: Poster Session A: Liver Transplantation: Viral Hepatitis
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Co-infection with HIV and viral hepatitis results in poorer outcomes following liver transplantation. In this population, complex immune status, extensive drug regimens, and comorbid conditions may contribute to poor graft outcomes. We describe a unique histological lesion found in post-transplant liver biopsies from patients co-infected with HIV and viral hepatitis, and sought to determine its clinical significance.
Methods: Patients with HIV and HCV and/or HBV were enrolled in a multicenter trial as part of the Solid Organ Transplantation Multisite Study between February 2003 and October 2009. Protocol biopsies were performed annually and for clinical indication. Patients with a unique combination of histologic findings not diagnostic for chronic HCV, obstruction, or rejection were included in additional analyses. This characteristic hepatitic/cholangiopathic liver lesion consisted of periportal ductular reaction in combination with hepatitis-like features (mild mononuclear portal and lobular infiltrates, apoptosis of hepatocytes, and variable hepatocyte swelling). Proportional hazards (PH) models were fit to identify predictors of the liver lesion. The impact of the lesion (as a time-varying covariate) on graft loss and death were evaluated using univariate PH models.
Results: Thirty-five (43%) cases of the lesion were identified among the 81 liver transplant recipients (including 7 kidney/liver recipients) with central biopsy readings. Of the 81 liver recipients, 21 were reported to have radiographic evidence of obstruction post-transplant (18 within 2 years of transplant). In the multivariate model, obstruction post-tx (HR: 4.6, p=0.005), detectable HIV RNA pre-tx (HR: 3.9, p=0.01), treated acute rejection (HR: 3.6, p=0.01) and higher nadir CD4 count pre-tx (HR: 1.22 per 50 cells/¯o;L, p=0.01) were all significantly associated with increased risk of lesion development post-transplant. In univariate PH models, development of the lesion was significantly associated with graft loss (HR= 2.3; 95% CI: 1.2-4.7; p=0.02) and death (HR= 2.8; 95% CI: 1.3-5.8; p=0.01).
Conclusion: This unique post transplant hepatitic/cholangiopathic liver lesion is associated with HIV viremia at the time of transplant, and results in an increased risk of graft loss and death.
To cite this abstract in AMA style:
Harbell J, Doherty A, Ferrell L, Barin B, Terrault N, Stock P. Combined Hepatitic/Cholangiopathic Lesion in HIV-HCV Co-Infected Liver Transplant Recipients Associated With Graft Loss [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/combined-hepatiticcholangiopathic-lesion-in-hiv-hcv-co-infected-liver-transplant-recipients-associated-with-graft-loss/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress