Clinical course and survival after liver transplantation for hepatitis B virus infection complicated by hepatocellular carcinoma
Wong, P.Y.; McPeake, J.R.; Portmann, B.; Tan, K.C.; Naoumov, N.V.; Williams, R.
American Journal of Gastroenterology 90(1): 29-34
1995
ISSN/ISBN: 0002-9270 PMID: 7801944 Document Number: 447561
Objectives and Methods: The outcome after liver transplantation for HBsAg-positive liver disease complicated by hepatocellular carcinoma is not clearly defined, and in the present study we analyzed the clinical course in 39 patients transplanted for hepatitis B virus (HBV)-related liver disease (group 1) compared with 16 patients with chronic HBV and hepatocellular carcinoma (group 2) and 52 patients with primary hepatocellular carcinoma seronegative for HBsAg (group 3). Results: Despite similar pretransplant viral serology, HBV recurred more often in patients with tumor (group 2) than in nontumor cases (group 1), with 1-yr actuarial cumulative reinfection rates of 85.4 % versus 65.0 %, respectively (p lt 0.05). In group 2 cases, we observed a more aggressive pattern of HBV-related graft injury with a higher frequency of graft loss (56.3% vs. 12.8%, p lt 0.001). Long-term outcome was worse in the group 2 cases, with 5-vr actuarial survival rates of 16.7% compared with 73.2% and 28.2% for groups 1 and 3, respectively. In group 2, recurrence of HBV in the graft, rather than tumor recurrence, was the principal cause of the high mortality observed (56.2% vs. 12.5%), which, in some cases, may have been potentiated by adjuvant chemotherapy. Conclusion: The poor outcome of patients transplanted for HBsAg-positive cirrhosis and hepatocellular carcinoma is due to HBV reinfection of the graft, rather than tumor recurrence. Antiviral agents in association with hepatitis B immunoglobulin would be the most promising approach to improving survival in this patient population.