Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients.
Citation: Surgery. 152(3):376-81, 2012 Sep.PMID: 22938898Institution: MedStar Washington Hospital CenterDepartment: Surgery/TransplantationForm of publication: Journal ArticleMedline article type(s): Clinical Trial | Journal Article | Multicenter Study | Research Support, N.I.H., ExtramuralSubject headings: *Graft Survival | *HIV Infections/ep [Epidemiology] | *Kidney Transplantation/sn [Statistics & Numerical Data] | *Liver Transplantation/sn [Statistics & Numerical Data] | *Postoperative Complications/ep [Epidemiology] | *Surgical Wound Dehiscence/ep [Epidemiology] | *Surgical Wound Infection/ep [Epidemiology] | Anastomotic Leak/ep [Epidemiology] | HIV Infections/su [Surgery] | Humans | Intraoperative Complications/ep [Epidemiology] | Kidney Transplantation/mo [Mortality] | Liver Transplantation/mo [Mortality] | Proportional Hazards Models | Prospective Studies | Reoperation | Survival Rate | Transplantation/sn [Statistics & Numerical Data] | Viral LoadLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:- 0039-6060
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | Available | 22938898 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
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.
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. Copyright 2012 Mosby, Inc. All rights reserved.
METHODS: Subjects were required to have CD4+ T-cell counts >200/100 cells/mm3 (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.
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