Liver transplantation for HBV-related cirrhosis in Europe: An ELTR study

Abstract

Background & Aims: HBV-related chronic liver disease is one of the most common indications for liver transplantation (LT) in Europe. The ELTR database was used to evaluate outcomes and evolution over 20 years (01/1988 and 12/2010).

Methods: HBV transplanted patients were analysed according to indication for LT: decompensated cirrhosis (HBVdec) or hepatocellular carcinoma (HBV/HCC). These groups were compared with co-infected patients HBV/HDV (HBDV), HBV/HCV (HBCV), HBV/HDV/HCV (HBDCV); n = 16,664 and with HCV patients (n = 2452) according to LT indication.

Results: 5912 patients were transplanted for HBV (78% HBVdec, 22% HBV/HCC), with HBV/HCC patients who increased from 15.8% in 1988-1995 to 29.6% in 2006-2010 (p <0.001). In HBVdec patients, 1, 3, 5, and 10 year patient and graft survival was 83%, 78%, 75%, 68%, and 80%, 74%, 71%, 64%, respectively, significantly better than HBV/HCC (84%, 73%, 68%, 61%, and 81%, 70%, 65%, 58% respectively; p = 0.001 and p = 0.026). In 2006-2010 patient and graft survival significantly improved compared to 1988-1995, both for HBVdec and HBV/HCC (each p <0.001). A better patient and graft survival was seen in HBV/HCC patients with HBV-DNA(-) compared to HBV-DNA(+) at the time of LT (p <0.001). Disease recurrence, as cause of death/graft loss, was significantly reduced in recent years compared to the past: currently <1% for HBVdec and 3% for HBV/HCC.

Conclusions: Outcomes of LT for HBV have improved in recent years, with disease recurrence being no longer a significant cause of death/graft loss. HBV-DNA at the time of LT seems to influence survival only in HBV/HCC patients. (C) 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

C1 [Burra, Patrizia; Germani, Giacomo; Russo, Francesco P.] Padova Univ Hosp, Multivisceral Transplant Unit, Dept Surg Oncol & Gastroenterol, I-35128 Padua, Italy.

[Adam, Rene; Karam, Vincent; Castaing, Denis] Univ Paris 11, ELTR, Hop Paul Brousse, AP HP,Ctr Hepatobiliaire, Villejuif, France.

[Marzano, Alfredo] Univ Turin, Osped San Giovanni Battista, I-10124 Turin, Italy.

[Lampertico, Pietro] Univ Milan, Div Gastroenterol 1, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Milan, Italy.

[Salizzoni, Mauro] Azienda Osped S Giovanni Battista, Ctr Trapianti Fegato, Turin, Italy.

[Filipponi, Franco] Azienda Osped Univ Pisana, Pisa, Italy.

[Klempnauer, Jurgen L.] Hannover Med Sch, Klin Viszeral & Transplantat Chirurg, D-30623 Hannover, Germany.

[Kilic, Murat] Ege Univ, Sch Med, Dept Surg, Div Hepatobiliary & Liver Transplantat, Izmir, Turkey.

[De Carlis, Luciano] UO Trapianto Fegato, Osped Niguarda Ca Granda, Milan, Italy.

[Neuhaus, Peter] Campus Virchow Klinikum, Charite, Klin Allgemein Viszeral & Transplantat Chirurg, Berlin, Germany.

[Yilmaz, Sezai] Inonu Univ, Tip Fak, Turgut Ozal Tip Merkezi, Malataya, Turkey.

[Paul, Andreas] Univ Klinikum Essen, CUK GHs Essen, Klin Allgemeine & Transplantat Chirurg, Essen, Germany.

[Pinna, Antonio D.] Univ Bologna, Policlin St Orsola Malpighi, Bologna, Italy.

[Burroughs, Andrew K.] Royal Free Hosp, Royal Free Sheila Sherlock Liver Ctr, London NW3 2QG, England.

[Burroughs, Andrew K.] Royal Free Hosp, Univ Dept Surg, London NW3 2QG, England.

[Burroughs, Andrew K.] UCL, London, England.