Liver transplantation and chronic HBV Infection: Risk Factors influencing viral recurrence and long term results
(2012) 24th International Congress of the Transplantation Society — Location: Berlin, Germany (15.July.2012)
Files
2012XXIVIntcongressTTS-Livertransplantationandchronic.pdf
Closed Access - Adobe PDF
- 279 KB
Details
- Authors
- Abstract
- Introduction: Without prophylaxis, viral allograft recurrence after liver transplantation (LT) is reported to be as high as 90%. Current prophylactic treatment options include administration of hepatitis B immunoglobulines (HBIG), nucleosides/nucleotides (NUC) or a combination of both. The optimal and most economical prophylaxis protocol remains controversial today. This study aims to analyzing long-term results after adult LT for HBV cirrhosis and identifying factors influencing viral recurrence. Methods: 97 primary LT for chronic HBV performed at the University Hospital, St. Luc, Brussels, Belgium, between February 1984 and July 2009 were retrospectively reviewed. Hepatitis delta virus (HBV-HDV) coinfection and hepatocellular carcinoma (HCC) were associated in 26% (n=25) and 41% (n=40), respectively. Median age was 46 years (range, 19 - 71). Median follow-up was 9 years (range, 2 - 26). Adequate immunoprophylaxis (ADIP) was defined as a level of HBsAb ≥ 100 UI/ ml. Recurrence of HBV was defined as the persistence of HBsAg or the reappearance of HBsAg and HBV DNA after initial HBsAg negativisation. 39 patients received HBIG only, and 25 patients received combined HBIG-NUC. Results: The 1, 5 and 10-years patient survival was 88%, 74%, and 65%, respectively. The 1, 5 and 10-years HBV recurrence free survival after LT for HBV cirrhosis without HDV coinfection (n=72) was significantly better in patients without active viral replication of HBV at moment of LT and in patient with ADIP (fig 1 and fig 2a+2b). After LT for HBV cirrhosis with HDV coinfection (n=25), ADIP significantly reduced the 1, 5, and 10-years HBV recurrence rate to 0% (p=0.005). The 1, 5, and 10-years HBV recurrence rate was significantly higher after LT with associated HCC independently of the viral replication status and the immunoprophylaxis status after LT (23%, 28% and 34% versus 12%, 16% and 22%, respectively for recipients with HCC and without HCC)(p=0.02). Conclusion: Long-term results after LT for HBV are excellent. ADIP with or without the use of NUC provides excellent recurrence free survival. The recurrence rate of HBV is always lower in recipients without viral replication at the moment of LT and in patients without HCC.
- Affiliations
Citations
Van Deun, S., Darius, T., Lai, Q., Ciccarelli, O., De Reyck, C., Roggen, F., Sempoux, C., Jovcevski, A., & Lerut, J. (2012). Liver transplantation and chronic HBV Infection: Risk Factors influencing viral recurrence and long term results. Transplantation, 94(10S), 106. https://hdl.handle.net/2078.5/31208 (Original work published 2012)