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Liver transplantation for HBV-related disease under immunosuppression with tacrolimus: an experience with 78
O Bronsther1, S Ersoz, M Tugcu
1Department of Surgery, University of Pittsburgh School of Medicine, Pa., USA.
Insights
Tacrolimus-based immunosuppression after liver transplantation for Hepatitis B viral liver disease (HBVLD) shows promising results. While recurrence occurs, many patients maintain normal liver function, with a low mortality rate from HBVLD recurrence.
Area of Science:
- Hepatology
- Transplant Surgery
- Virology
Background:
- Hepatitis B viral liver disease (HBVLD) affects over 300 million globally, with limited effective therapies beyond liver transplantation.
- Orthotopic liver transplantation (OLTx) is the primary treatment for end-stage HBVLD, but recurrence remains a concern.
- The impact of tacrolimus-based immunosuppression on HBVLD recurrence post-OLTx was previously unreported.
Purpose of the Study:
- To investigate the outcomes of OLTx in patients with HBVLD treated with tacrolimus-based immunosuppression.
- To assess the rate and impact of HBV disease recurrence in this patient cohort.
Main Methods:
- Retrospective review of 78 consecutive patients undergoing OLTx for HBVLD between 1990 and 1991.
- Tacrolimus was the primary immunosuppressant used.
- HBV disease recurrence was monitored using serologic and histologic methods up to April 1, 1993.
Main Results:
- 73% (57/78) of patients survived with a median follow-up of 24 months.
- 31% (31/57) of survivors experienced HBV recurrence, but 18 of these maintained normal liver function.
- Mortality directly due to recurrent HBVLD was 10.9% (8/78). Preoperative HBeAg positivity was associated with higher recurrence and mortality.
Conclusions:
- Tacrolimus-based immunosuppression appears feasible for OLTx in HBVLD patients, with a significant proportion experiencing recurrence but maintaining good liver function.
- HBeAg positivity is a risk factor for recurrence and poorer outcomes.
- Further research is needed to optimize immunosuppression strategies and prevent recurrence in HBVLD patients post-OLTx.
Abstract:
Hepatitis B viral liver disease (HBVLD) is a major worldwide health problem. It is estimated over 300 million people have had hepatitis B virus infection and that one-third of these have chronic HBVLD. Little effective therapy exists for HBVLD even though high dose interferon (IFN) has been advocated. For those who either are untreated or do not respond to IFN, HBVLD is steadily progressive and orthotopic liver transplantation (OLTx) is the only available therapy. Until quite recently, all OLTx recipients received cyclosporine (CyA) and prednisone. The consequence of OLTx for HBV disease in individuals immunosuppressed with tacrolimus has not previously been reported. A total of 78 consecutive patients with HBV-related liver diseases who were transplanted between January 1, 1990, and December 31, 1991, and treated with tacrolimus were studied. The clinical records of these patients were reviewed retrospectively. HBV disease recurrence was documented with serologic and histologic methods. As of April 1, 1993, 57 of 78 (73%) of the patients were still alive. Thirty-one of the alive patients have documented HBV recurrence. Eighteen of these 31 patients, however, have normal liver function. With a median follow-up of 24 months, 8 patients (10.9%) have died of recurrent HBVLD. Seven of 8 patients, who preoperatively were HBeAg+, developed recurrence and 4 of these patients have already died of recurrence. Patients who were HBsAg+ rarely recurred (1 of 16 patients). The use of HBIG did not prevent recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)