{
  "abstract": "Background Liver transplantation (LT) is nowadays increasingly feasible in people with HIV, yet knowledge on long-term outcomes is limited. This study aims to provide a two-decade experience on people with HIV undergoing LT compared to non-HIV recipients.Methods Retrospective matched case–control study including all recipients with HIV (RWH) who consecutively underwent LT at the University Hospital of Modena between 2003 and 2024. Each RWH was matched 1:3 with non-HIV recipients using a propensity-score model based on age, sex, MELD, presence of hepatocellular carcinoma (HCC) at transplant, HBV and/or HCV co-infection, and donor age. Long-term graft and recipients’ survival, occurrence of acute rejection (AR) and HCC recurrence were evaluated using Kaplan-Meier curves. Predictors of AR were explored using logistic regression.Results Eighty-seven liver RWH were included: 88% with history of drug injections, 20% with previous opportunistic infections and a median HIV duration of 25 years (IQR 20-31); at transplant, 95.4% had undetectable HIV RNA with CD4 cell count of 278 cell/mm3 (IQR 201-405). RWH were matched with 261 non-HIV recipients. Baseline characteristics were comparable (median age 53 years, IQR 47-58; 17% females) except for higher prevalence of HCV co-infection among RWH versus non-HIV recipients (93.1% vs 66.7%, p<0.01). Ten-year and 15-year graft survival was 78.7% and 60.1% in RWH vs 81.6% and 72.6% in non-HIV recipients, respectively ( figure 1a); the overall recipients’ survival was also comparable both at 10 years (59.6% vs 66.7%) and 15 years (48.9% vs 53.1%) (figure 1b). HCC recurred in 10% of cases in both groups, with a post-transplant IR of 1.8 (95% CI 1.0-3.5) in HIV vs 1.4 (95% CI 1.0-2.1) in non-HIV per 100 PYFU (p=0.519), although time to recurrence tended to be longer in HIV recipients [2.4 (IQR 1.2-6.7) vs 0.8 (IQR 0.6-1.6) years, p=0.06]. Recurrent HCC reduced significantly survival compared (p <0.001), without difference according to HIV serostatus (p=0.426) (figure 2a-b).The incidence rate (IR) of AR was 5.5 (95% CI 3.3-9.3) in RWH vs 0.8 (95% CI 0.5-1.2) in non-HIV per 100 PYFU. Among transplants performed after 2015, 1-year rejection IR decreased to 1.1 (95% CI 0.3-4.6) in RWH vs 0.9 (95% CI 0.2-3.9) in non-HIV recipients per 100 PYFU (figure 3a-b). Predictors of rejection were HIV infection (aOR 2.43, 95%CI 1.10-5.32), CMV infection/reactivation (aOR 3.25, 95%CI 1.25-8.47), and active HCV infection (aOR 2.40, 95%CI 1.10-5.24); after 2015, only CMV infection/reactivation was associated to rejection (table 1).Conclusion LT in HIV achieves good long-term outcomes comparable to non-HIV recipients. After 2015, thanks to the advent of effective anti-HCV treatment and the disuse of protease inhibitors, HIV infection was no more associated to higher risk of rejection. HCC recurred in about 10%, without any difference between HIV and non-HIV, though impacting on survival even after HCV eradication.Abstract OC12 Figure 1–3Abstract OC12 Table 1Predictors of acute rejection overall and in liver recipients after 2015",
  "authors": [
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy"
      ],
      "name": "A Cervo"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "M Albertini"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "F Casari"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "J Milic"
    },
    {
      "affiliations": [
        "Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, Modena, Italy"
      ],
      "name": "B Catellani"
    },
    {
      "affiliations": [
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy",
        "Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, Modena, Italy"
      ],
      "name": "P Magistri"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "E Franceschini"
    },
    {
      "affiliations": [
        "Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, Modena, Italy"
      ],
      "name": "GP Guerrini"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "C Mussini"
    },
    {
      "affiliations": [
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy",
        "Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena, Modena, Italy"
      ],
      "name": "F Di Benedetto"
    },
    {
      "affiliations": [
        "Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy",
        "Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy"
      ],
      "name": "G Guaraldi"
    }
  ],
  "title": "OC12 Long-term outcomes in liver transplant recipients: comparison between patients living with and without HIV infection",
  "uid": "d658789b-31de-5a3d-8d8b-e49d7af8d091"
}