Liver Transplantation for Hepatitis B Virus Patients: Long-Term Results of Three Therapeutic Approaches

• Published in: Transplantation proceedings 2008-07, Vol.40 (6), p.1961-1964
• Main Authors: Avolio, A.W, Nure, E, Pompili, M, Barbarino, R, Basso, M, Caccamo, L, Magalini, S, Agnes, S, Castagneto, M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis B - mortality; Hepatitis B - surgery; Human viral diseases; Humans; Immunization, Passive; Immunoglobulins - therapeutic use; Infectious diseases; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Middle Aged; Recurrence; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Viral diseases; Viral hepatitis
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.05.071

Abstract The indications for liver transplantation among patients with post-hepatitis B virus (HBV)-related cirrhosis have changed over the past 35 years. We reviewed the long-term results of 47 patients treated with liver transplantation for HBV-related cirrhosis. Patients were classified into 3 groups according to the perioperative regimen. In the initial experience, no immunoprophylaxis was adopted (no-IP; n = 5). From 1988–1996, an immunoprophylaxis scheme was adopted (HBIg; n = 16). From 1997–2007, we adopted the combination of lamivudine and HBIg (LAM-HBIg; n = 26). We calculated the prevalence of serological reinfection and patient survival at 1 to 20 years, using the 3 regimens. The recurrence rate was 75% in the group of untreated patients; 30% in the HBIg group; and 9% in the LAM-HBIg group. The overall survival was 67% at 5 years, and 64% at 10 and 20 years. The long-term survival for each of the 3 therapeutic approaches, namely, for the patients who did not receive any treatment, for the HBIg group, and for the LAM-HBIg group, were 20%, 50%, and 84%, respectively. We suggest to use the LAM-HBIg combination.