Survival after liver transplantation for chronic hepatitis B using reduced immunosuppression

• Published in: Journal of hepatology 1995-03, Vol.22 (3), p.257-262
• Main Authors: Gish, Robert G., Keeffe, Emmet B., Lim, Janet, Brooks, Linda J., Esquivel, Carlos O.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Aged; Biological and medical sciences; Chronic Disease; Chronic hepatitis B; Female; Follow-Up Studies; Graft Rejection; Hepatitis B - complications; Hepatitis B - mortality; Hepatitis B - surgery; Hepatitis B virus - physiology; Hepatitis D - complications; Humans; Immunization, Passive; Immunoglobulins - therapeutic use; Immunomodulators; Immunosuppression; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Recurrence; Retrospective Studies; Survival Rate; Virus Replication
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/0168-8278(95)80276-2

Background/Aims: Recurrent hepatitis B virus infection after liver transplantation performed for chronic hepatitis B with cirrhosis is influenced by a number of factors, including coinfection with the hepatitis D virus, the level of HBV replication, and administration of hepatitis B immune globulin. Another potentially important factor in modulating HBV infection after liver transplantation is the degree of immunosuppression post-transplant. We reviewed an institutional experience with liver transplantation for chronic hepatitis B and analyzed the impact of using lower doses of corticosteroids on HBV reinfection, expression of recurrent HBV disease and patient survival. Methods: Of 17 patients undergoing liver transplantation for chronic hepatitis B, 16 patients received variable doses of hepatitis B immune globulin for up to 6 months. Results: Fifteen of the 16 patients remained HBsAg-negative during hepatitis B immune globulin therapy, but ultimately 13 of the 17 patients had HBV reinfection, including 3 of 4 patients with hepatitis D virus coinfection. Long-term survival (82%) of the 17 chronic hepatitis B patients was not different from the survival (75%) of 195 patients transplanted for other indications. Three of 13 patients who were reinfected died from chronic hepatitis B with liver failure. Reinfection did not appear to be related to the pretransplant degree of viral replication. Compared to an age- and sex-matched control group, patients undergoing liver transplantation for chronic hepatitis B received less cumulative intravenous methylprednisolone and oral prednisone, but did not experience a higher rate of graft rejection. Conclusions: We postulate that use of lower doses of corticosteroids after liver transplantation for chronic hepatitis B is safe and not associated with a higher incidence of graft rejection. Moreover, low-dose maintenance prednisone therapy may modify the course of post-transplant HBV reinfection by leading to less viral replication, milder HBV-related liver disease and better patient survival.