Liver Transplantation for HCC in HIV-Infected Patients: Long-Term Single-Center Experience

• Main Authors: Gian Piero Guerrini, Massimiliano Berretta, Giovanni Guaraldi, Paolo Magistri, Giuseppe Esposito, Roberto Ballarin, Valentina Serra, Stefano Di Sandro, Fabrizio Di Benedetto
• Format: Article
• Language: English
• Published: MDPI AG 2021-09-01
• Series: Cancers
• Subjects: AFP = alpha-fetoprotein; CI = confidence interval; HCC = hepatocellular carcinoma; HR = hazard ratio; LT = liver transplantation; MELD = model for end-stage liver disease
• Online Access: https://www.mdpi.com/2072-6694/13/18/4727

Background: HIV-infected patients now have long life expectation since the introduction of the highly active antiretroviral therapy (HAART). Liver diseases, especially cirrhosis and hepatocellular carcinoma (HCC), currently represent a leading cause of death in this setting of patients. Aim: To address the results of liver transplantation (LT) for HCC in HIV-infected patients. Methods: All patients with and without HIV infection who underwent LT for HCC (n = 420) between 2001 and 2021 in our center were analyzed with the intent of comparing graft and patient survival. Cox regression analysis was used to determine prognostic survival factors and logistic regression to determine the predictor factors of post-LT recurrence. Results: Among 1010 LT, 32 were HIV-infected recipients. With an average follow-up of 62 ± 51 months, 5-year overall survival in LT recipients with and without HIV-infection was 71.6% and 69.9%, respectively (<i>p</i> = ns), whereas 5-year graft survival in HIV-infected and HIV-non infected was 68.3% and 68.2%, respectively (<i>p</i> = ns). The independent predictive factor of survival in the study group was: HCV infection (HR 1.83, <i>p</i> = 0.024). There were no significant differences in the pathological characteristics of HCC between the two groups. The logistic regression analysis of the study population demonstrated that microvascular invasion (HR 5.18, <i>p</i>< 0.001), HCC diameter (HR 1.16, <i>p</i> = 0.028), and number of HCC nodules (HR 1.26, <i>p</i> = 0.003) were predictors of recurrence post-LT. Conclusion: Our study shows that HIV patients undergoing LT for HCC have comparable results in terms of post-LT survival. Excellent results can be achieved for HIV-infected patients with HCC, as long as a strategy of close surveillance and precise treatment of the tumor is adopted while on the waiting list.