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Liver transplantation in cirrhosis due to hepatitis D virus infection
D Samuel1, H Bismuth, J P Benhamou
1Hôpital Paul Brousse, Villejuif, France.
Insights
Liver transplantation is successful for hepatitis D virus (HDV) cirrhosis patients. With anti-HBs immunoglobulins, hepatitis B virus (HBV) reinfection rates are low, indicating good transplant candidacy.
Area of Science:
- Hepatology
- Virology
- Transplantation Medicine
Background:
- Hepatitis D virus (HDV) infection causes severe cirrhosis.
- Liver transplantation is a treatment option for end-stage liver disease.
- Hepatitis B virus (HBV) reinfection post-transplant is a significant concern.
Purpose of the Study:
- To evaluate the rate of HBV reinfection in patients transplanted for HDV cirrhosis.
- To compare HBV reinfection rates across different pre-transplant HBV DNA statuses.
- To assess the outcomes of liver transplantation for HDV-related cirrhosis.
Main Methods:
- Retrospective analysis of 49 patients transplanted for HDV cirrhosis.
- Administration of anti-HBs immunoglobulins post-transplantation.
- Monitoring of HBV and HDV reinfection rates at 2 years.
- Comparison with historical control groups based on HBV DNA status.
Main Results:
- A 2-year HBV reinfection rate of 13% was observed in HDV cirrhosis patients receiving immunoglobulins.
- This rate is significantly lower than 29% for HBV-DNA-negative and 96% for HBV-DNA-positive cirrhosis.
- HBV reinfection was linked to HDV reinfection; transient HDV replication occurred without hepatitis in some cases.
Conclusions:
- Patients with HDV cirrhosis are suitable candidates for liver transplantation.
- Anti-HBs immunoglobulin prophylaxis is effective in reducing HBV recurrence.
- Liver transplantation offers a favorable outcome for selected patients with HDV-related liver disease.
Abstract:
In a series of 49 patients transplanted for cirrhosis due to hepatitis D virus (HDV) infection and receiving anti-HBs immunoglobulins, the 2-year actuarial rate of hepatitis B virus (HBV) reinfection was only 13%, a prevalence much lower than the 29% rate in patients transplanted for HBV-DNA-negative cirrhosis and the 96% rate in patients transplanted for HBV-DNA-positive cirrhosis. HBV reinfection after transplantation in patients with cirrhosis due to HDV infection was invariably associated with HDV reinfection. In a few patients, in the absence of HBV reinfection, transient replication of HDV took place and was not associated with liver lesions of hepatitis. In conclusion, patients with cirrhosis due to HDV infection are good candidates for liver transplantation.