Early post-liver transplant surgical morbidity in HIV infected recipients: risk factor for overall survival? A nationwide retrospective study

AIM: To analyze the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival(OS) in HIV infected patients submitted to liver transplantation. METHODS: Retrospective study on a nationwide multicenter cohort of 157 HIV patients submitted to liver transplantation in 6 Italian Transplant Units between 2004-2014. RESULTS: An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak(8.2%), bleeding(8.2%), intestinal perforation(4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared to a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. CONCLUSIONS: In HIV liver transplanted patients, increasing number of early relaparotomies due to surgical complications did negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy were associated with increased risk of early relaparotomy. This article is protected by copyright. All rights reserved.