Presenter Name: Mikel Gastaca,...

22
Presenter Name: Mikel Gastaca, MD Presenter Affiliation/Institution: Hepatobiliary Surgery and Liver Transplantation Hospital de Cruces. Bilbao. Spain I have no financial relationships to disclose within the past 12 months relevant to my presentation My presentation does not include discussion of off-label or investigational use

Transcript of Presenter Name: Mikel Gastaca,...

Page 1: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Presenter Name: Mikel Gastaca, MD

Presenter Affiliation/Institution: Hepatobiliary Surgery and Liver Transplantation Hospital de Cruces. Bilbao. Spain

I have no financial relationships to disclose within the past 12 months relevant to my presentation

My presentation does not include discussion of off-label or investigational use

Page 2: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

1Hosp. Cruces, Bilbao; 2Hosp. Univ. Vall d´Hebrón, Barcelona; 3Hosp. Bellvitge, Barcelona; 4Hosp. Clinic-IDIBAPS, Barcelona; 5Hosp. Ramón y Cajal, Madrid;

6Hosp. 12 de Octubre, Madrid; 7Hosp. Gragorio Marañon, Madrid; 8Hosp. La Fe, Valencia

1Hosp. Cruces, Bilbao; 2Hosp. Univ. Vall d´Hebrón, Barcelona; 3Hosp. Bellvitge, Barcelona; 4Hosp. Clinic-IDIBAPS, Barcelona; 5Hosp. Ramón y Cajal, Madrid;

6Hosp. 12 de Octubre, Madrid; 7Hosp. Gragorio Marañon, Madrid; 8Hosp. La Fe, Valencia

Spanish Cohort of HIV-Infected Patients with Orthotopic Liver Transplantation (OLT): Evaluation of 112 Cases in the Highly Active Antiretroviral (HAART)

Era (2002-07).

Spanish Cohort of HIV-Infected Patients with Orthotopic Liver Transplantation (OLT): Evaluation of 112 Cases in the Highly Active Antiretroviral (HAART)

Era (2002-07).Mikel Gastaca1,

Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5, F. Pulido6, PilarMiralles7, Martín Prieto8, Jose R. Fernandez1, Jose M. Miro4, and the Spanish LT in HIV-Infected Patients Working Group.

Mikel Gastaca1,Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5, F. Pulido6, Pilar

Miralles7, Martín Prieto8, Jose R. Fernandez1, Jose M. Miro4, and the Spanish LT in HIV-Infected Patients Working Group.

Page 3: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

To describe the baseline clinical characteristics and the evolution of

112 Spanish HIV-1-infected patients who underwent liver transplantation

(OLT) in the highly active antiretroviral (HAART) era (2002-

2007).

To describe the baseline clinical characteristics and the evolution of

112 Spanish HIV-1-infected patients who underwent liver transplantation

(OLT) in the highly active antiretroviral (HAART) era (2002-

2007).

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OBJECTIVEOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OBJECTIVE

Page 4: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

• Prospective study of all HIV-1-infected patients who underwent OLT in Spain.

• HIV (stage, CD4 cell count, plasma HIV-1 RNA viral load, ART), liver disease (etiology, stage) and OLT characteristics at baseline and after OLT were collected using an standardized CRF.

• Each site used the same immunosuppressive regimens & prophylaxis protocols as for their HIV-negative patients.

• Cohort study. Descriptive analysis.

• Prospective study of all HIV-1-infected patients who underwent OLT in Spain.

• HIV (stage, CD4 cell count, plasma HIV-1 RNA viral load, ART), liver disease (etiology, stage) and OLT characteristics at baseline and after OLT were collected using an standardized CRF.

• Each site used the same immunosuppressive regimens & prophylaxis protocols as for their HIV-negative patients.

• Cohort study. Descriptive analysis.

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

PATIENTS & METHODSOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

PATIENTS & METHODS

Page 5: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OLT INCLUSION CRITERIAOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OLT INCLUSION CRITERIA• Liver criteria: the same as for the non-HIV-1

infected population.• HIV criteria: No previous C events (CDC, 1993)

except some OIs (TB, PCP, Can), pre-OLT CD4 cell count greater than 100 cells/mm3 and undetectable plasma RNA HIV-1 viral load on HAART or detectable plasma viral load off HAART with post-transplant suppression predicted.

• Drug abuse: A) No heroin or cocaine abuse for >2 years; B) No alcohol abuse for >6 months.

• Liver criteria: the same as for the non-HIV-1 infected population.

• HIV criteria: No previous C events (CDC, 1993) except some OIs (TB, PCP, Can), pre-OLT CD4 cell count greater than 100 cells/mm3 and undetectable plasma RNA HIV-1 viral load on HAART or detectable plasma viral load off HAART with post-transplant suppression predicted.

• Drug abuse: A) No heroin or cocaine abuse for >2 years; B) No alcohol abuse for >6 months.

Page 6: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

OLT in Spanish HIV-infected patients in the HAART era (2002-07) (N=112*)

OLT in Spanish HIV-infected patients in the HAART era (2002-07) (N=112*)

0

5

10

15

20

25

30

2002 2003 2004 2005 2006 2007

OLT-HIV

* 5 patients had retransplantation.* 5 * 5 patients had retransplantationpatients had retransplantation..

Page 7: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Spanish Cohort of OLT in HIV-infected patients(FIPSE OLT-HIV-05 / GESIDA 45-05 )(N=112)

Spanish Cohort of OLT in HIV-infected patients(FIPSE OLT-HIV-05 / GESIDA 45-05 )(N=112)

5119*H Cruces Bilbao141H Carlos Haya Málaga2210H La Fé Valencia2113H Bellvitge Hospitalet Llobregat2212*H General Vall D'Hebrón Barcelona249*H Clínic I Provincial Barcelona212H Virgen de la Arrixaca Murcia409*H Gregorio Marañón Madrid2711H 12 de Octubre Madrid316H Reina Sofía Córdoba102H Univ Virgen del Rocío Sevilla328H Ramón y Cajal Madrid023H Central de Asturias Oviedo022C Hosp Juan Canalejo La Coruña101H Univ Marqués de Valdecilla Santander012C Hosp Univ Santiago de Compostela004*H Clínico Lozano Blesa Zaragoza

DeathWaiting

ListOLT

* 5 patients had retransplantation.* 5 * 5 patientspatients hadhad retransplantationretransplantation..

Page 8: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Demographics (N=107*)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Demographics (N=107*)

Male genderAge (years)HIV risk factor- Former i.v. drug abuse- Sexual- Hemophilia- OtherRace: Caucasian

Male Male gendergenderAgeAge ((yearsyears))HIV HIV riskrisk factorfactor-- FormerFormer i.v. drug abusei.v. drug abuse-- SexualSexual-- HemoHemophiliaphilia-- OtherOtherRace: CaucasianRace: Caucasian

79 (74%)42 (39;46)**

79 (74%)17 (16%)3 (3%)4 (4%)

103 (96%)

79 (74%)79 (74%)42 (39;46)**42 (39;46)**

7979 ((7474%)%)1717 ((1616%)%)3 (3%)3 (3%)4 (4%)4 (4%)

103 (96%)103 (96%)* 5 did not meet the HIV inclusion criteria ** Median (IQR).* 5 * 5 diddid notnot meetmeet thethe HIV HIV inclusioninclusion criteriacriteria ** ** MeMediandian ((IQRIQR))..

Page 9: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Liver cirrhosis etiology*- HCV- HBV**- HCV+HBV**Child-Pugh stage- A- B- CMELD (median [IQR])

Liver cirrhosis etiologyLiver cirrhosis etiology**-- HCVHCV-- HBV**HBV**-- HCV+HBV**HCV+HBV**ChildChild--PughPugh stagestage-- AA-- BB-- CCMELDMELD (median [IQR])(median [IQR])

84 (75%)5 (5%)

13 (12%)

13 (12%)45 (42%)44 (41%)14 [10;19]

84 (75%)84 (75%)5 (5%)5 (5%)

13 (13 (1212%)%)

1313 ((1212%)%)4545 ((4242%)%)4444 (41%)(41%)14 [10;114 [10;199]]

*16 patients (18%) had a hepatocellular carcinoma (HCC). HCV genotypes 1/4 in 57 (67%); genotypes 2/3 in 18 (21%). 10 cases had a non-typable genotype.

** Delta co-infection in six cases.

*16*16 papatients (18%) tients (18%) had had a a hepatocellular hepatocellular carcinoma (HCC). carcinoma (HCC). HCV HCV genotypes genotypes 1/4 in 57 (67%); 1/4 in 57 (67%); genotypes genotypes 2/32/3 in 18 (21%). in 18 (21%). 10 cases 10 cases had had a a nonnon--typable genotypetypable genotype. .

** Delta ** Delta coco--infection infection in in six six cases.cases.

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Liver disease characteristics (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Liver disease characteristics (N=107)

Page 10: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

ART regimens- Efavirenz-based ART- PI-based ART- 3/4 NRTI*- Other combinations

CD4 count (cel./mm3)CV < 200 copies/mL

ART ART regimensregimens-- EfavirenzEfavirenz--based based ARTART-- PIPI--based based ARTART-- 3/4 3/4 NRTI*NRTI*-- Other combinationsOther combinations

CD4CD4 countcount ((cceell./mm3)./mm3)CV < CV < 20200 0 copicopiees/mL s/mL

41 (38%)30 (28%)11 (10%)25 (23%)

276 (170;408)**101 (94%)

4141 (38%)(38%)30 (28%)30 (28%)11 (10%)11 (10%)25 (23%)25 (23%)

227676 (170(170;;408408)**)**101 (94%)101 (94%)

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

ART characteristics before OLT (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

ART characteristics before OLT (N=107)

* Abacavir-based ART; ** Median (IQR).* * AbacavirAbacavir--basedbased ART; ** ART; ** MeMediandian ((IQRIQR))..

Page 11: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Time on waiting list (mo.)

Type of liver- Cadaveric- Living-donor

Follow-up (mo.)

Time Time on waiting liston waiting list (m(mo.o.))

Type of liverType of liver-- CadaverCadavericic-- LivingLiving--donordonor

FollowFollow--up up ((momo.).)

4 (2-7)*

92%1%

13 (6-29)**

4 (24 (2--77)*)*

9292%%11%%

1313 ((66--2299)**)**

* Median (IQR); ** Four patients required re-transplantation. * * MeMediandian ((IQRIQR); ** ); ** Four patients required reFour patients required re--transplantation. transplantation.

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OLT Characteristics (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

OLT Characteristics (N=107)

Page 12: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Hospitalization stay (days)

Surgical complications- Biliary fistula

Acute RejectionChronic Rejection

Re-transpantation- PNF- Art. thrombosis- HCV recurrence

HospitalizationHospitalization staystay (days)(days)

SurgicalSurgical complicationscomplications-- BiliaryBiliary fistulafistula

AcuteAcute RejectionRejectionChronicChronic RejectionRejection

ReRe--transpantationtranspantation-- PNFPNF-- Art. Art. thrombosisthrombosis-- HCV HCV recurrencerecurrence

21 (16-37)*

59 (55%)12

47 (44%)2 (2%)

5 (5%)212

2121 (1(166--3737)*)*

59 (55%)59 (55%)1212

47 (44%)47 (44%)2 (2%)2 (2%)

5 (5%)5 (5%)221122

* Median (IQR).* * MeMediandian ((IQRIQR).).

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Post-Operative Outcome (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Post-Operative Outcome (N=107)

Page 13: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

ANTIRETROVIRAL THERAPY (ART)- Re-started in all cases a median (IQR) time of 10 (4; 19) daysafter OLT.

HIV DISEASE PROGRESION- Six C events: CMV (2), VZV (2), PCP and TB one case each.

ANTIRETROVIRAL THERAPY (ART)ANTIRETROVIRAL THERAPY (ART)-- ReRe--startedstarted in in allall cases a median (IQR) time cases a median (IQR) time ofof 10 (4; 19) 10 (4; 19) daysdaysafterafter OLT.OLT.

HIV DISEASE PROGRESIONHIV DISEASE PROGRESION-- SixSix C C eventsevents: CMV (2), VZV (2): CMV (2), VZV (2), , PCP PCP andand TB TB oneone case case eacheach..

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

HIV & ART after OLT (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

HIV & ART after OLT (N=107)

CD4+ cells/µLMedian (IQR)

CD4+ cells/µLMedian (IQR)

Plasma HIV-1 RNAVL<200 copies/mLPlasma HIV-1 RNAVL<200 copies/mL

Before OLT+ 3 mo (N=92)+ 12 mo (N=70)+ 24 mo (N=39)+ 36 mo (N=23)+ 48 mo (N=14)

Before OLT+ 3 mo (N=92)+ 12 mo (N=70)+ 24 mo (N=39)+ 36 mo (N=23)+ 48 mo (N=14)

94%93%94%92%95%93%

94%93%94%92%95%93%

276 (170;408)288 (193;420)309 (197;424)260 (197;470)262 (156;500)258 (156;372)

276 (170;408276 (170;408)288 (193;420)309 (197;424)260 (197;470)262 (156;500)258 (156;372)

Page 14: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

Early mortality (<6 mo.)- Post-op. complications- Severe cholestatic HCV hepatitis- Other*Late mortality (>6 mo.)- Graft ELSD – HCV reinfection- Chronic rejection- Other**

EarlyEarly mortalitymortality (<6 (<6 momo.).)-- PostPost--op. complicationsop. complications-- Severe Severe cholestaticcholestatic HCV hepatitisHCV hepatitis-- OtherOther**Late mortality (>6 mo.)Late mortality (>6 mo.)-- Graft ELSD Graft ELSD –– HCV HCV reinfectionreinfection-- Chronic rejectionChronic rejection-- OtherOther****

8 (29%)422

20 (71%)947

88 (29%)(29%)442222

20 (71%)20 (71%)994477

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Mortality (N=28; 26%)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Mortality (N=28; 26%)

* Massive variceal bleeding and lactic acidosis – mitochondrial toxicity; ** MOF (2), OI (2), Cancer, mucormicosis and lactic acidosis – mitochondrial toxicity. * Massive * Massive varicealvariceal bleeding and lactic acidosis bleeding and lactic acidosis –– mitochondrial toxicity; mitochondrial toxicity; ** MOF (2), OI (2), Cancer, ** MOF (2), OI (2), Cancer, mucormicosismucormicosis and lactic acidosis and lactic acidosis –– mitochondrial toxicity. mitochondrial toxicity.

Page 15: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

72% (60-81%)

88% (78-93%)

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Patient Survival (N=83)*OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Patient Survival (N=83)*

65% (51-75%)

65% (51-75%)

83Patientsat risk 70 37 21 14

* * SurvivalSurvival analysisanalysis waswas performedperformed includingincluding onlyonly patientspatients underwentunderwent OLT OLT betweenbetween 2002 2002 andand2006 2006 andand followedfollowed untiluntil DecemberDecember 31st, 2007.31st, 2007.

Page 16: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

HIV -HIV +

Patientsat risk

YearsHIV + HIV -

Cumulative survival after OLT, comparing 83 HIV-positive and 1,499 HIV-negative HBV- or HCV-positive

OLT recipients (2002-07).

Cumulative survival after OLT, comparing 83 HIV-positive and 1,499 HIV-negative HBV- or HCV-positive

OLT recipients (2002-07).

1499 1093 766 495 30083 70 37 21 14

P=P=.5306.5306

1202

Page 17: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

• The first case of OLT in Spain was performed in January 2002. Since then, 107 patients have beentransplanted within the Spanish criteria at 17 (90%) sites.

• Most cases of OLT in Spain were due to HCV-infectionin former i.v. drug users.

• HCV re-infection is the major cause of mortality after OLT (39,3%).

• The first case of OLT in Spain was performed in January 2002. Since then, 107 patients have beentransplanted within the Spanish criteria at 17 (90%) sites.

• Most cases of OLT in Spain were due to HCV-infectionin former i.v. drug users.

• HCV re-infection is the major cause of mortality after OLT (39,3%).

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

CONCLUSIONSOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

CONCLUSIONS

Page 18: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

• HIV disease can be adequately controlled after OLT.

• At present, OLT for selected HIV-1-infected patients is a safe and effective procedure with a short and mid-term survival that is comparable to the HIV-negative population.

• HIV disease can be adequately controlled after OLT.

• At present, OLT for selected HIV-1-infected patients is a safe and effective procedure with a short and mid-term survival that is comparable to the HIV-negative population.

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

CONCLUSIONSOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

CONCLUSIONS

Page 19: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

ACKNOWLEDGEMENTSOLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

ACKNOWLEDGEMENTS- Fundación para la Investigación y Prevención del SIDA en España (FIPSE).- Grupo de Estudio de Sida (GESIDA/SEIMC).- Sociedad Española de Trasplante Hepático (SETH).- Grupo de Estudio de Infecciones en Trasplantados. (GESITRA/SEIMC).

- Secretaria del Plan Nacional del Sida (SPNS) del Ministerio de Sanidad y Consumo (MSC).- Organización Nacional de Trasplante (ONT).

Our patients.

- Fundación para la Investigación y Prevención del SIDA en España (FIPSE).- Grupo de Estudio de Sida (GESIDA/SEIMC).- Sociedad Española de Trasplante Hepático (SETH).- Grupo de Estudio de Infecciones en Trasplantados. (GESITRA/SEIMC).

- Secretaria del Plan Nacional del Sida (SPNS) del Ministerio de Sanidad y Consumo (MSC).- Organización Nacional de Trasplante (ONT).

Our patients.

Page 20: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,
Page 21: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

OLT in Spanish HIV-infected patients in the HAART era (2002-07) (N=112*)

OLT in Spanish HIV-infected patients in the HAART era (2002-07) (N=112*)

0

5

10

15

20

25

30

35

2002 2003 2004 2005 2006 2007

AliveDeath

*5 patients had retransplantation; ** OLT in HIV-infected recipients/OLT in general population ratio.*5 *5 patientspatients hadhad retransplantationretransplantation; ** OLT in HIV; ** OLT in HIV--infectedinfected recipientsrecipients/OLT in general /OLT in general populationpopulation ratio.ratio.

0.5%** 1.5% 1.8% 3.0% 2.6%1.5%

Page 22: Presenter Name: Mikel Gastaca, MDfundacionseimcgesida.org/apartados/archivos/2/4505-oralatc-2008.pdf · Mikel Gastaca1, Miguel Montejo1, LLuis Castells2, A. Rafecas3, Rafael Bárcena5,

53%11%6%

51%5%3%11%

53%53%11%11%6%6%

5151%%5%5%3%3%11%11%

- Cyclosporine A (CsA)+ Prednisone, or+ IL-2 Ra*, or+ Prednisone plus MMF

- Tacrolimus+ Prednisone, or+ Prednisone + MMF**+ Prednisone + IL-2 Ra*+ MMF or IL-2 Ra*

-- CyclosporineCyclosporine A (A (CsACsA))+ + PrednisonePrednisone, , oror+ IL+ IL--2 2 RaRa*, *, oror+ + PrednisonePrednisone plus MMFplus MMF

-- TacrolimusTacrolimus+ + PrednisonePrednisone, , oror+ + PrednisonePrednisone + MMF**+ MMF**+ + PrednisonePrednisone + IL+ IL--2 2 RaRa**+ MMF + MMF oror ILIL--2 2 RaRa**

*Basiliximab (Simulect®); ** MMF = Mycophenolate mophetil; # p=0.21; RR=1.55 [0.88-2.71])**BasiliximabBasiliximab ((SimulectSimulect®); ** MMF = ®); ** MMF = MycophenolateMycophenolate mophetilmophetil; ; # # p=0.21; RR=1.55 [0.88p=0.21; RR=1.55 [0.88--2.71])2.71])

OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Immunosuppressive regimens (N=107)OLT in Spanish HIV-1-infected patients in the HAART era (2002-07)

Immunosuppressive regimens (N=107)

54%54%54%

35%35%35%

AcuteRejection#

AcuteAcuteRejectionRejection##