Trasplante hepático en pacientes con infección por VIH : Pronóstico del carcinoma hepatocelular y del retrasplante
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Document Type
Document Version
Author
Director
Miro Meda, José M.
Rimola Castellá, Antonio
Rimola Castellá, Antonio
Tutor
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Publication Date
Pages
393 p.
Embargo date
Citation
Agüero, F. Trasplante hepático en pacientes con infección por VIH : Pronóstico del carcinoma hepatocelular y del retrasplante. Universitat Pompeu Fabra; 2015. handle: http://hdl.handle.net/10803/400133
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Doctoral program
Programa de doctorat en Biomedicina
Abstract
En el año 2010 existían dos escenarios en los cuales la evidencia relacionada con la efectividad del trasplante hepático en pacientes con infección por VIH era muy escasa. Uno de ellos era el retrasplante hepático y el otro era la indicación de trasplante hepático por carcinoma hepatocelular. El objetivo global de esta tesis doctoral fue determinar la supervivencia de los pacientes con infección por VIH en estos dos escenarios y la tasa de recidiva post-trasplante de carcinoma hepatocelular así como determinar los factores pronósticos asociados a dichos resultados. Los resultados del retrasplante hepático se analizaron en 2 estudios de cohorte. Un estudio incluyó casos con infección por VIH y controles no infectados por VIH (n=14 vs. 157, respectivamente) sometidos a retrasplante hepático en España y el otro estudio internacional incluyó pacientes infectados por VIH sometidos a retrasplante hepático en los 8 países participantes (n=37). Por su parte, para el estudio sobre el carcinoma hepatocelular se utilizaron los datos de pacientes cuya indicación de trasplante hepático era carcinoma hepatocelular con controles emparejados por variables de interés (n=74 vs. 222, respectivamente). Se concluye que los pacientes con infección por VIH que no tienen replicación del VHC en el momento del retraspante hepático tienen una supervivencia post-trasplante satisfactoria. En los pacientes con replicación por el VHC, el retrasplante hepático deberá reevaluarse con la introducción de los nuevos antivirales directos frente al VHC. Finalmente, los pacientes infectados por el VIH trasplantados por carcinoma hepatocelular tienen una tasa de supervivencia y de recidiva tumoral similar a controles sin infección por VIH.
In 2010 there were two scenarios in which the evidence related to the effectiveness of liver transplantation in patients with HIV infection was scant. One was the liver retransplantation and the other was the indication for liver transplantation for hepatocellular carcinoma. The overall objective of this thesis was to determine the survival rates of patients with HIV infection in these two scenarios and the rate of post-transplant hepatocellular carcinoma recurrence and to determine prognostic factors associated with these outcomes. The results of liver retransplantation were analyzed in two cohort studies. One study included cases of HIV infection and HIV-uninfected controls (n=14 vs. 157, respectively) who underwent liver retransplantation in Spain . The second study enrolled HIV-infected patients undergoing liver retransplantation in the 8 participating countries (n=37). For the study of hepatocellular carcinoma, HIV-infected patients whose indication for liver transplantation was hepatocellular carcinoma were matched with controls without HIV-infection (n=74 vs. 222, respectively). It is concluded that patients with HIV who do not have HCV replication at the time of liver retraspantation have satisfactory post-transplant survival rates. In patients with HCV replication, liver retransplantation should be reassessed in the near future with the introduction of new direct antivirals against HCV. Finally, HIV-infected patients undergoing liver transplantation for hepatocellular carcinoma have survival and post-transplant tumor recurrence rates similar to controls without HIV infection.
In 2010 there were two scenarios in which the evidence related to the effectiveness of liver transplantation in patients with HIV infection was scant. One was the liver retransplantation and the other was the indication for liver transplantation for hepatocellular carcinoma. The overall objective of this thesis was to determine the survival rates of patients with HIV infection in these two scenarios and the rate of post-transplant hepatocellular carcinoma recurrence and to determine prognostic factors associated with these outcomes. The results of liver retransplantation were analyzed in two cohort studies. One study included cases of HIV infection and HIV-uninfected controls (n=14 vs. 157, respectively) who underwent liver retransplantation in Spain . The second study enrolled HIV-infected patients undergoing liver retransplantation in the 8 participating countries (n=37). For the study of hepatocellular carcinoma, HIV-infected patients whose indication for liver transplantation was hepatocellular carcinoma were matched with controls without HIV-infection (n=74 vs. 222, respectively). It is concluded that patients with HIV who do not have HCV replication at the time of liver retraspantation have satisfactory post-transplant survival rates. In patients with HCV replication, liver retransplantation should be reassessed in the near future with the introduction of new direct antivirals against HCV. Finally, HIV-infected patients undergoing liver transplantation for hepatocellular carcinoma have survival and post-transplant tumor recurrence rates similar to controls without HIV infection.
Keywords
HIV, Liver transplantation, Retransplantation, Hepatocellular carcinoma, Survival, VIH, Trasplante hepático, Retransplante, Carcinoma hepatocelular, Supervivencia
Subjects
616.3 - Pathology of the digestive system. Dentistry
Publisher
Universitat Pompeu Fabra
