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Chronic Hepatitis B in the Transplant Setting: A 30-Year Experience in a Single Tertiary Italian Center

Francesco Paolo Russo1,2, Sara Battistella1,2, Alberto Zanetto1,2

  • 1Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, 35125 Padua, Italy.

Viruses
|April 26, 2025
PubMed

Insights

Hepatitis B virus (HBV) is a major reason for liver transplants (LT). High-barrier nucleos(t)ide analogues (hbNUCs) have improved outcomes for patients on the waiting list, making hepatocellular carcinoma (HCC) the primary indication for LT.

Area of Science:

  • Hepatology
  • Transplantation Medicine
  • Virology

Background:

  • Hepatitis B virus (HBV) infection is a significant driver for liver transplantation (LT).
  • Long-term outcomes of HBV-positive patients undergoing LT require continuous evaluation.
  • Trends in LT indications and waiting list (WL) management for HBV patients are evolving.

Purpose of the Study:

  • To assess long-term patient and graft survival in Hepatitis B surface antigen (HBsAg)-positive LT recipients over 30 years.
  • To analyze trends and outcomes for HBsAg-positive patients after inclusion on the LT waiting list (WL) over 15 years.
  • To evaluate the impact of hepatitis delta virus (HDV) coinfection and transplant indications on LT outcomes.

Main Methods:

  • Retrospective analysis of 321 HBsAg-positive LT recipients and 284 waitlisted patients from 1991-2020 at Padua Hospital.
  • Stratification based on HDV coinfection, transplant indication (decompensated cirrhosis vs. hepatocellular carcinoma [HCC]), and WL inclusion period.
  • Evaluation of survival rates and the impact of high-barrier nucleos(t)ide analogues (hbNUCs) and post-transplant prophylaxis (HBIG + NUCs).

Main Results:

  • 1- and 5-year patient/graft survival rates were 87.6%/86.7% and 82.6%/82.2%, respectively.
  • Hepatocellular carcinoma (HCC) was more prevalent in HBsAg-positive patients on the WL compared to non-HBV patients (p = 0.008).
  • hbNUCs significantly reduced mortality (p = 0.041) and improved survival post-WL inclusion (p = 0.007), with consistent outcomes across different indications and coinfections.
  • Minimal HBV reactivation occurred with HBIG + NUCs prophylaxis.

Conclusions:

  • HBV remains a primary indication for LT, with consistent prevalence over 30 years.
  • The introduction of hbNUCs has improved WL outcomes and shifted the main LT indication to HCC.
  • Long-term survival after LT for HBV is robust, irrespective of HDV coinfection or specific indication.
Abstract

Keywords:
HBIGHBVHBV prophylaxisHDVNUCsliver transplantation

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