Recurrent hepatitis B infection after liver transplantation for hepatitis B related diseases in Asian population: long term results of a single centre

Abstract

OBJECTIVES: To report long term results of prophylactic antiviral medication to prevent recurrent hepatitis B virus (HBV) infection after liver transplantation (LT) for HBV related liver disease in Asian population from a single centre. BACKGROUND: HBV related liver disease is prevalent in Asian population and accounts for majority of LT in Queen Mary Hospital. LT is curative for most patients with HBV related liver diseases. However, recurrent HBV infection may proceed to chronic liver disease and results in graft loss or even death. We adopt oral antiviral medications (nucleoside analog, Lamivudine or Entecavir) before and after LT as therapeutic and prophylaxis to prevent recurrent HBV infection. METHODS: A retrospective study from prospective database. All recipients of LT for HBV related diseases between September 1995 and December 2007 were recruited. Incidence of recurrent HBV infection and outcomes were analyzed. Patients divided into groups 1 and 2 with or without recurrent HBV infection respectively and were compared. RESULTS: 358 Patients had undergone LT for HBV related diseases within the study period. 77(22%) patients have recurrent HBV infection defined as serum HBsAg positive. Median follow-up for 2 groups of patients as mentioned were comparable (59.8 vs 68.6 months, p=0.23). There was no significant difference in pre-transplant (pre-LT) HBeAg and HBV DNA positivity (p=0.841, 0.081 respectively). Duration of pre-LT antiviral medication was comparable (p=0.544). There was significantly more deceased donor liver transplantation (DDLT) in patients with recurrent HBV infection (p=0.017). Patients with recurrent HBV infection had significantly more HBV related morbidity (p=0.046) but not in mortality (p=0.215). There was no significant difference in re-transplantation between 2 groups (4% vs 2%, p=0.411). Overall 1-, 3- and 5-year survival was comparable (p=0.164). CONCLUSIONS: Oral antiviral prophylaxis can effectively prevent recurrent HBV infection and achieve good outcomes after liver transplantation for HBV related liver diseases in long term.