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Living donor liver transplantation for hepatitis B cirrhosis
Zeki Karasu1, Murat Akyildiz, Murat Kilic
1Department of Gastroenterology, Ege University Medical School, Bornova, Izmir, Turkey.
Insights
Living donor liver transplantation (LDLT) combined with antiviral therapy and hepatitis B immune globulin (HBIg) shows excellent outcomes for patients with chronic hepatitis B virus (HBV) infection, with low recurrence rates.
Area of Science:
- Hepatology
- Transplant Surgery
- Infectious Diseases
Background:
- Hepatitis B virus (HBV) infection is a leading cause of cirrhosis in Turkey.
- Living donor liver transplantation (LDLT) offers advantages in regions with limited deceased donor organs.
- LDLT facilitates preemptive antiviral therapy for HBV patients.
Purpose of the Study:
- To evaluate the outcomes of LDLT in patients with chronic HBV infection at a single institution.
- To assess the efficacy of antiviral prophylaxis and hepatitis B immune globulin (HBIg) in preventing HBV recurrence post-transplant.
Main Methods:
- A cohort of 109 patients with chronic HBV infection underwent LDLT between 1999 and 2005.
- Patients received antiviral prophylaxis (lamivudine or adefovir) pre- and post-transplant.
- Post-transplant prophylaxis included low-dose intramuscular HBIg combined with antiviral agents.
Main Results:
- No donor mortality was observed.
- One-year recipient survival rate was 90%, with no HBV-related deaths.
- HBV recurrence occurred in 5.5% of recipients, with no correlation to donor hepatitis B core antibody status.
Conclusions:
- LDLT, coupled with antiviral treatment and low-dose HBIg, yields excellent results for both donors and recipients.
- This approach effectively manages chronic HBV infection in the context of liver transplantation.
- The strategy demonstrates a low rate of HBV recurrence, ensuring graft survival.
Background And Aim:
Living donor liver transplantation (LDLT) has particular advantages for Turkey where hepatitis B virus (HBV) infection is the most common cause of cirrhosis, both because LDLT circumvents the difficulties encountered in the emerging world in providing deceased donor organs, and because it allows preemptive antiviral therapy. The aim of this study was to review one institution's experience with LDLT in patients with chronic HBV infection.
Methods:
A total of 109 patients with chronic HBV infection underwent LDLT between September 1999 and June 2005, of whom 40 were coinfected with hepatitis D virus and 23 had hepatocellular carcinoma. Antiviral prophylaxis was attempted in all, beginning prior to transplantation with lamivudine or adefovir, and continuing after transplantation with low dose intramuscular hyperimmune B immunoglobulin (HBIg) plus lamivudine or adefovir.
Results:
In a median follow up of 20 months (range 1-66 months), there was no donor mortality. One-year recipient survival was 90%, and in total 16 recipients died. None of the deaths was related to HBV. Recurrence of HBV infection was detected by reappearance of serum hepatitis B surface antigen in six patients (5.5%) at 5, 8, 12, 17, 34 and 46 months after transplantation, respectively. There was no influence of donor hepatitis B core antibody status on the likelihood of recurrence of HBV in the allograft.
Conclusion:
The results indicate that LDLT with antiviral treatment and low dose HBIg provides excellent results for donors and recipients.
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