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Published on: February 19, 2019
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.
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.
Background:
Hepatitis B virus (HBV) remains a leading etiology for liver transplantation (LT). In a large cohort of HBsAg-positive patients, this study evaluates long-term patient and graft survival after LT over the past 30 years while analyzing trends and outcomes following waiting list (WL) inclusion over the last 15 years.
Methods:
HBsAg-positive patients who underwent transplantation between 1991 and 2020 and were waitlisted from 2006 to 2020 at Padua Hospital were included in the analysis. Patients were stratified according to hepatitis delta virus (HDV) coinfection, transplant indication (decompensated cirrhosis vs. hepatocellular carcinoma (HCC)), and WL inclusion period.
Results:
Among 321 HBsAg-positive LT recipients (31.5% HDV-coinfected, 46.4% HCC), 1-year and 5-year patient/graft survival rates were 87.6%/86.7% and 82.6%/82.2%, respectively. From 2006 to 2020, 284 HBsAg-positive patients were waitlisted (32.6% HDV-coinfected), with a significantly higher prevalence of HCC compared to non-HBV patients (p = 0.008). High-barrier nucleos(t)ide analogues (hbNUCs) significantly reduced mortality (p = 0.041) and improved survival post-WL inclusion (p = 0.007). Survival rates were consistent regardless of LT indication, HDV coinfection, or WL inclusion period. Post-transplant prophylaxis predominantly involved immunoglobulins (HBIG) + NUCs, resulting in only two cases of HBV reactivation, both clinically inconsequential.
Conclusions:
Over the past 30 years, HBV has remained a consistent indication for LT at our center. Thanks to hbNUCs, WL outcomes have improved and HCC has become the main indication for LT.
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