Increased Success with Liver Transplant in HBV ...

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Increased Success with Liver Transplantation in HBV Patients By Brian Boyle, MD End stage liver disease is a common cause of morbidity and mortality in patients with chronic active hepatitis B virus (HBV) infection. In earlier studies, liver transplantation in these patients had relatively poor outcomes, generally due to HBV reinfection and transplant-related complications. A recent study indicates, however, that with appropriate antiviral treatment following liver transplantation "excellent long-term results can be achieved." In the study, published in Hepatology, investigators evaluated their experience with liver transplantation in patients with end stage liver disease due to chronic HBV who were concomitantly treated with immunoprophylaxis, including the use of available antiviral treatments. At their center, a total of 228 liver transplants were performed in 206 patients with chronic HBV infection from 1988 to 2000. The transplants were performed due to acute liver failure (10%), HBV cirrhosis alone (67%) or HBV with hepatitis D virus (HDV) (13%), or hepatitis C virus (HCV) (7%) coinfection. All patients received long-term immunoprophylaxis and from 1993 and 1996 HBV DNA-positive patients were treated before and after surgery with famciclovir or lamivudine, respectively. Overall, the 1, 5, and 10 year patient survival rates were 91%, 81%, and 73%, respectively. In patients with hepatocellular carcinoma or HBV reinfection survival was significantly impaired, with 5 year survival rates of 60% and 69%, respectively, and being hepatitis B e antigen (HBeAg) positive prior to surgery was also associated with a decreased survival. Those with HDV or HCV coinfection had a trend toward better survival than with HBV monoinfection. In contrast, a preoperative positive HBV DNA was associated with a trend toward poorer patient survival. Two-year patient survival increased from 85% during 1988 to 1993 to 94% during 1997 to 2000 (P < .05). The 2-year recurrence rates in these 2 time frames were 42% and 8%, respectively (P < .05). The authors conclude, "excellent long-term results can be achieved in hepatitis B patients after liver transplantation with modern strategies, and survival rates are similar to other indications. Based on our experience, hepatitis B patients, including those with active viral replication, should not be excluded from liver transplantation." 05/31/02 Reference T Steinm黮ler and others. Increasing applicability of liver transplantation for patients with hepatitis B-related liver disease. Hepatology 2002; 35:1528-1535. by HIV and Hepatitis.com. All Rights Reserved (for use within thewww.hbvhbv.net only)