MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates

Aruna Subramanian, Mark Sulkowski, Burc Barin, Donald Stablein, Michael Curry, Nicholas Nissen, Lorna Dove, Michelle Roland, Sander Florman, Emily Blumberg, Valentina Stosor, D. T. Jayaweera, Shirish Huprikar, John Fung, Timothy Pruett, Peter Stock, Margaret Ragni

Research output: Contribution to journalArticle

Abstract

Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P <.0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P <.0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

Original languageEnglish (US)
Pages (from-to)159-164
Number of pages6
JournalGastroenterology
Volume138
Issue number1
DOIs
StatePublished - Jan 2010

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End Stage Liver Disease
HIV
Transplants
Mortality
Liver
Virus Diseases
CD4 Lymphocyte Count
Hepacivirus
RNA
Organ Transplantation
Liver Transplantation
Disease Progression
Liver Diseases

ASJC Scopus subject areas

  • Gastroenterology

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MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates. / Subramanian, Aruna; Sulkowski, Mark; Barin, Burc; Stablein, Donald; Curry, Michael; Nissen, Nicholas; Dove, Lorna; Roland, Michelle; Florman, Sander; Blumberg, Emily; Stosor, Valentina; Jayaweera, D. T.; Huprikar, Shirish; Fung, John; Pruett, Timothy; Stock, Peter; Ragni, Margaret.

In: Gastroenterology, Vol. 138, No. 1, 01.2010, p. 159-164.

Research output: Contribution to journalArticle

Subramanian, A, Sulkowski, M, Barin, B, Stablein, D, Curry, M, Nissen, N, Dove, L, Roland, M, Florman, S, Blumberg, E, Stosor, V, Jayaweera, DT, Huprikar, S, Fung, J, Pruett, T, Stock, P & Ragni, M 2010, 'MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates', Gastroenterology, vol. 138, no. 1, pp. 159-164. https://doi.org/10.1053/j.gastro.2009.09.053
Subramanian, Aruna ; Sulkowski, Mark ; Barin, Burc ; Stablein, Donald ; Curry, Michael ; Nissen, Nicholas ; Dove, Lorna ; Roland, Michelle ; Florman, Sander ; Blumberg, Emily ; Stosor, Valentina ; Jayaweera, D. T. ; Huprikar, Shirish ; Fung, John ; Pruett, Timothy ; Stock, Peter ; Ragni, Margaret. / MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates. In: Gastroenterology. 2010 ; Vol. 138, No. 1. pp. 159-164.
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abstract = "Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4{\%}); this mortality rate was similar to that of controls (88/792, 11.1{\%}, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7{\%}) underwent liver transplantation, compared with controls (47.6{\%}, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P <.0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P <.0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.",
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T1 - MELD Score Is an Important Predictor of Pretransplantation Mortality in HIV-Infected Liver Transplant Candidates

AU - Subramanian, Aruna

AU - Sulkowski, Mark

AU - Barin, Burc

AU - Stablein, Donald

AU - Curry, Michael

AU - Nissen, Nicholas

AU - Dove, Lorna

AU - Roland, Michelle

AU - Florman, Sander

AU - Blumberg, Emily

AU - Stosor, Valentina

AU - Jayaweera, D. T.

AU - Huprikar, Shirish

AU - Fung, John

AU - Pruett, Timothy

AU - Stock, Peter

AU - Ragni, Margaret

PY - 2010/1

Y1 - 2010/1

N2 - Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P <.0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P <.0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

AB - Background & Aims: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. Methods: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. Results: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P <.0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4+ cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P <.0001). Conclusions: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4+ cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.

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