We describe the indications, clinical characteristics, and outcome of liver retransplantation (reLT) in HIV-infected patients included in 8 prospective national cohorts.

Methods: We analyzed data from 37 HIV-infected patients who underwent reLT between 1997 and 2012 in Spain (14 patients), USA (9), Italy (5), Germany (4), UK (2), Switzerland (1), Portugal (1), and Argentina (1).

Results: Median (IQR) age was 47 (43-50) years. The indication of primary liver transplantation (LT) was cirrhosis by HCV, HCV and HBV, or HBV infection in 28, 4, and 5 cases, respectively. At primary LT, median (IQR) CD4 cells/mm3 was 295 (210-396) and plasma viral load was <200 copies/mL in 97% of cases. ReLT was indicated because of vascular thrombosis, primary graft non-function, chronic rejection, HCV recurrence, and other indications in 13, 7, 6, 6, and 5 cases, respectively. ReLT was urgent (early, ≤30 days) in 19 cases (51%) and elective (late, >30 days) in 18 cases (49%). Median (IQR) MELD at reLT was 23 (21-31). After a median (IQR) follow-up of 32 (3-63) months, 19 (51%) of the patients died. Overall, patient survival after reLT at 1, 3, and 5 years was 62%, 56% and 49%, respectively. Survival at 1 and 3 years after early reLT (N=19) vs late reLT (N=18) was 47% vs 78% and 42% vs 72%, respectively (p=0.186). Survival at 1 and 3 years for HIV/HCV-coinfected patients with a negative (N=10) vs a positive (N=22) plasma HCV RNA viral load at reLT was 80% vs 50% and 80% vs 41%, respectively (p=0.044). HCV recurrence was the main cause of death (7 cases, 32%). HIV infection was controlled with antiretroviral therapy after reLT in most cases.

Conclusions: Medium-term survival after reLT was poor in HIV-infected patients. Post-reLT outcome was better among HIV/HCV-coinfected patients with undetectable plasma HCV RNA at reLT.

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