Introduction Hepatitis B virus (HBV) infection is a major cause of liver disease. Nearly 350 million worldwide have chronic infection and around 600 000 persons die each year from consequences of HBV. Liver transplantation (LT) is an excellent treatment for HBV-related cirrhosis and hepatocellular carcinoma (HCC). Oral-antiviral therapy is effective in suppressing HBV replication. Before the introduction of oral anti-viral therapy the indications for LT were mainly fulminant liver failure (FHF) and hepatic decompensation. However, with availability of effective oral antiviral medication, there has been a change in the indication for LT in HBV infected patients, and the largest proportion has well compensated cirrhosis with HCC.
Aim To analyse the indication and outcome of LT for HBV patients in our unit over 24 years.
Method Retrospective database analysis of HBV related LT from 1986 to 2010. Indications, demographics, viral load, co-infection, oral anti-viral therapy, and outcome were examined.
Results 121 patients with HBV were transplanted. 18 recipients were female, average age at time of transplant was 50. 36 were Asian, 8 were of African descent. Lamivudine prophylaxis for viral load suppression was usually used for those who were transplanted after year 1993 and median viral load pre-LT for this patient group was 103 (range 102–106) copies/ml. 58/121 had LT between 2000 and 2010, and 63 before 2000. 12.6% (8/63) had LT for FHF before year 2000, and only 7%(4/58) since 2000 (p=0.2). 14 (22%) transplanted pre-2000 and 31 (54%) post-2000 had HCC (p<0.001). Median pre-LT bilirubin was 57 mmol/l (pre-2000) vs 31 (post-2000) (p=0.003) and median pre-LT INR was 1.7 (pre-2000) vs 1.2 (p<0.001) but pre-LT creatinine was not significant between two groups. Three patients had regraft (1=HAT; 1=PNF; 1=recurrence). There were 9 deaths related to recurrent HBV in patients transplanted pre-2000 and 1 death in patients transplanted post 2000. There are three recurrent HCC pre 2000 and five recurrent HCC post-2000. The difference in survival between the two groups approaches statistical significance (p=0.13). 69 patients are alive, eight patients are followed abroad. All patients were treated with Lamivudine post-LT. Since 2000, Lamivudine was used in combination with Adefovir for 11 patients and Tenofovir for three patients pre-LT to suppress viral replication. One patient was on Entecavir pre-LT.
Conclusion There is a change in the indication for LT in HBV patients since the introduction of oral antiviral therapy. An increasing proportion has well compensated liver disease with HCC as the indication for LT.
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