Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

HIV-positive patients have shorter survival periods while awaiting liver transplants

07.11.2005


A new study on HIV-positive patients eligible for liver transplants found that their survival while waiting for a transplant is significantly shorter than patients who are HIV-negative. Other than infection, which caused many of the deaths, there appear to be no other factors that predict a poor outcome for these patients.



The results of this study appear in the November 2005 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

HIV-positive patients progress more rapidly to end-stage liver disease (ESLD), a condition requiring transplant, but post-transplant survival has improved in recent years, possibly because of advances in antiretroviral therapy. However, some patients do not survive long enough to undergo a transplant. Led by Margaret V. Ragni at the University of Pittsburgh School of Medicine, researchers studied whether poorer survival prior to transplant is related to the severity of either liver disease or HIV disease in these patients.


A total of 58 patients who were HIV-positive with ESLD were evaluated for transplant eligibility at the University of Pittsburgh Medical Center between 1997 and 2002. These patients were followed, along with 1,359 HIV-negative patients who were also evaluated for transplant. Of the 58 HIV-positive patients, 48 percent died before a transplant was performed, compared with 16 percent of the HIV-negative group. In addition, the survival period was much shorter in the HIV-positive group (880 versus 1,427 days), but the severity of their ESLD was no worse than the HIV-negative group. More than half of the deaths in the HIV-positive patients were due to infection.

The findings indicate that the development of ESLD in HIV-positive patients is associated with a high risk of early death. Speculating as to why this is the case, the authors state that "when ESLD develops in an HIV-positive individual, the already defective host defense against infection attributed to HIV may be further weakened by the immune defects associated with liver failure, resulting in a greater vulnerability of the HIV-positive candidate to infection or sepsis [an infection in the blood]." They further suggest that patients with HIV infection should be evaluated for transplant earlier in the course of their ESLD, as they appear to be at greater risk for infection, and that studies on whether prophylactic antibiotics may have a role in preventing this scenario may be warranted. They conclude: "Until then, it would seem prudent to monitor HIV-positive transplant candidates very closely for early signs of infection, inform them of the potential risk for infection, and urge them to seek medical attention at the earliest signs or symptoms of infection."

In the same issue, an accompanying editorial by Peter G. Stock, of the Department of Surgery at the University of California in San Francisco, CA notes that the study is the first documentation of a more rapid demise of HIV-patients awaiting transplant, adding that the importance of early transplant referral for these patients cannot be underestimated. The author suggests that transplant referral for HIV-positive patients may be delayed because HIV infection is still perceived by physicians as a barrier to undergoing a transplant, and these patients may therefore not be encouraged to meet the necessary transplant prerequisites in a timely manner, such as abstaining from alcohol and narcotics. In addition, the time it takes for the various specialists caring for HIV patients to coordinate a referral to a transplant center may be partially responsible for the delay. Also, by the time liver function in HIV infected patients deteriorates enough to warrant a transplant, they may no longer meet other criteria. The author notes that additional organs for these patients might be obtained via living donor grafts, which is not without risks to both donor and recipient, or the use of high infectious risk donors, excluding those who are HIV-positive. Although there is some concern about HIV transmission during a transplant procedure, the author states that the risk is actually much lower than the risk of transmission of Hepatitis C virus through a needle-stick. He concludes that "synchronized multi-special care along with early referral will help to minimize the number of deaths on the waiting lists and facilitate excellent outcomes following liver transplantation in this deserving group of recipients."

David Greenberg | EurekAlert!
Further information:
http://www.interscience.wiley.com/journal/livertransplantation

More articles from Studies and Analyses:

nachricht WAKE-UP provides new treatment option for stroke patients | International study led by UKE
17.05.2018 | Universitätsklinikum Hamburg-Eppendorf

nachricht First form of therapy for childhood dementia CLN2 developed
25.04.2018 | Universitätsklinikum Hamburg-Eppendorf

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Explanation for puzzling quantum oscillations has been found

So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics

Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...

Im Focus: Dozens of binaries from Milky Way's globular clusters could be detectable by LISA

Next-generation gravitational wave detector in space will complement LIGO on Earth

The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...

Im Focus: Entangled atoms shine in unison

A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.

The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...

Im Focus: Computer-Designed Customized Regenerative Heart Valves

Cardiovascular tissue engineering aims to treat heart disease with prostheses that grow and regenerate. Now, researchers from the University of Zurich, the Technical University Eindhoven and the Charité Berlin have successfully implanted regenerative heart valves, designed with the aid of computer simulations, into sheep for the first time.

Producing living tissue or organs based on human cells is one of the main research fields in regenerative medicine. Tissue engineering, which involves growing...

Im Focus: Light-induced superconductivity under high pressure

A team of scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg investigated optically-induced superconductivity in the alkali-doped fulleride K3C60under high external pressures. This study allowed, on one hand, to uniquely assess the nature of the transient state as a superconducting phase. In addition, it unveiled the possibility to induce superconductivity in K3C60 at temperatures far above the -170 degrees Celsius hypothesized previously, and rather all the way to room temperature. The paper by Cantaluppi et al has been published in Nature Physics.

Unlike ordinary metals, superconductors have the unique capability of transporting electrical currents without any loss. Nowadays, their technological...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Save the date: Forum European Neuroscience – 07-11 July 2018 in Berlin, Germany

02.05.2018 | Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

 
Latest News

Supersonic waves may help electronics beat the heat

18.05.2018 | Power and Electrical Engineering

Keeping a Close Eye on Ice Loss

18.05.2018 | Information Technology

CrowdWater: An App for Flood Research

18.05.2018 | Information Technology

VideoLinks
Science & Research
Overview of more VideoLinks >>>