Prognosis in liver transplantation recipients after hepatitis B virus recurrence

To analyze the data from hepatitis B virus (HBV) infected patients with HBV recurrence after orthotopic liver transplantation (OLT) to determine their prognosis and survival.

We retrospectively analyzed data from patients who experienced HBV recurrence following OLT at our center between January 2000 and September 2011. All patients were monitored until June 2012 or their death.

The total number of cases of HBV recurrence after liver transplantation was 56. Of these cases, 21 had benign liver disease and 35 had hepatocellular carcinoma (HCC). The median follow-up time was 48.8 months (range: 5.0-138.1 months). The median time to recurrence following transplantation was 44.4 months (range: 0.3-116.3 months) and 12.2 months (range: 0.3-135.1 months) for patients with benign liver disease and HCC, respectively. Nine patients were diagnosed with HBV recurrence first (1.2-8.2 months prior to HCC recurrence), seven patients showed HCC recurrence first (0.4-27.1 months prior to HBV recurrence), and the remaining 5 patients had HBV and HCC recurrence at the same time. Correlation analysis demonstrated a strong correlation between HBV and HCC recurrence times. Of the 56 patients with HBV recurrence, 24 had died at the time of data cut off, and the main cause of death was HCC recurrence. In patients with malignant liver disease, the survival rates were 78.8%, 48.8%, and 40.1% at 1, 3, and 5 years, respectively, which were lower than those in patients with benign liver disease, which were 94.7%, 89.5%, and 77.5% at 1, 3, and 5 years, respectively, P=0.001.

Patients with HBV recurrence and benign liver disease have a better prognosis than HCC patients. Treatment with the addition of adefovir and/or entecavir is necessary for patients with HBV recurrence. A correlation between HBV and HCC recurrence times was observed. Hepatitis B recurrence can be used as a warning signal for tumor recurrence.