Surgical complications in 275 HIV-infected liver and/or kidney transplantation recipients.

MedStar author(s):
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
Name of journal: SurgeryAbstract: 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.All authors: Barin B, Bartlett ST, Florman SS, Fung J, Hanto DW, Harbell J, HIV-TR Investigators, Light J, Nissen N, Olthoff K, Pearson TC, Roland ME, Stock PG, Tzakis AGDigital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
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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