Liver transplantation for hepatitis B liver disease and concomitant hepatocellular carcinoma in the United States With hepatitis B immunoglobulin and nucleoside/nucleotide analogues

Abstract

7Methodist Hospital, Houston, TX Reinfection with hepatitis B virus (HBV) after liver transplantation (LT) may favor the recurrence of hepatocellular carcinoma (HCC), and combination therapy with hepatitis B immunoglobulin (HBIG) and nucleoside/nucleotide analogues may reduce HBV recurrence after LT. To test associations between HBV, HCC, and survival, we performed a retrospective chart review of patients undergoing LT for HBV between January 1985 and December 2010 at 7 US transplant centers. After we divided the patients into 3 eras based on evolving strategies in antiviral therapy (1985-1994, 1995-2004, and 2005-2010), we reviewed 16 variables to determine whether there were associations between survival and HCC recurrence. Seven hundred thirty-eight patients underwent transplantation for HBV, and 354 (48.0%) had concomitant HCC, which recurred in 58 patients (16.4%). Three-year survival was much better in era 3 versus era 1 (87% versus 40%, P 5 0.001), and the incidence of HCC recurrence was lower (12% versus 29%, P 5 0.009). The lungs were the most frequent first site of HCC recurrence, and they were followed by the liver. A multivariate analysis showed that HBV reinfection, HCC recurrence, and HBIG use were associated with worse survival (P < 0.001, P < 0.001, and P 5 0.002, respectively); HCC recurrence and stage 3 HCC, among other factors, were associated with HBV reinfection (P < 0.001 and P 5 0.004); and stage 3 HCC, vascular invasion of the explanted tumor, and post-LT chemotherapy were associated with HCC recurrence (P 5 0.008, P < 0.001, and P < 0.001, respectively). Patients with HBV reinfection were 3.6 times more likely than patients without HBV to have HCC recurrence. These data suggest further study of attempts at LT for patients with HBV and HCC beyond the Milan criteria if their HBV is aggressively and successfully treated. Liver Transpl 19:1020-1029, 2013. V C 2013 AASLD.Received November 14, 2012; accepted June 3, 2013.Orthotopic liver transplantation (LT) has become the preferred treatment for patients with hepatitis B virus (HBV)-mediated end-stage liver disease.1-3 Although HBV was originally a contraindication to transplantation, now the 5-year survival rates following LT for HBV-related disease are similar to those for other

Tenofovir disoproxil fumarate rescue therapy for HBV recurrence in two liver transplant recipients with previous multiple nucleo(s/t)ide treatment failures

“…Although HBIG combined with NUCs (mainly LAM) after LT has been the most effective prophylaxis regimen for HBV recurrence in clinical practice until now, HBV recurrence was associated with graft loss, HCC recurrence, and significantly decreased survival rate in LT recipients [8,9]. Furthermore, recent studies have found that high preoperative HBV DNA load (>10 5 copies/ml), HBV mutation, and HCC in the explant liver were independent risk factors for HBV recurrence following LT [10].…”

Oxaliplatin Plus S1 for Treating Sorafenib-Refractory Recurrent Hepatocellular Carcinoma after Liver Transplantation

“…Histopathologic examination revealed poorly differentiated HCC around 9 × 7 × 7 cm, grade ¾ without lymphovascular invasion. Hepatitis B immunoglobulin (HBIG) and entecavir were taken for HBV treatment and HBV DNA subsequently turned negative after that [10]. Rapamycin-based post-transplant immunoprophylaxis without steroids was subsequently initiated after transplantation.…”

Overview of the Indications and Contraindications for Liver Transplantation

“…This mandatory duration of abstinence is a matter of debate because the 6-mo threshold has shown to be insufficient for predicting long-term graft and patient survival (Rice and Lucey 2013). Although uncontrolled systemic infections, which exclude patient survival under immunosuppression, and AIDS-defining symptoms in HIV patients are absolute contraindications, the possibility of performing a liver transplantation in patients diagnosed with infections such as HBV and HIV and controllable local infections must be assessed for each individual patient (Grossi 2003;Tavio et al 2011;Campsen et al 2013). Further absolute contraindications for liver transplantation are life-limiting medical conditions such as advanced cadiovascular, pulmonary, or neurologic disorders; intrahepatic CCA; hepatic metastases other than neuroendocrine metastases in selected patients; and extrahepatic malignancy (see also Lakkis and Lechler 2013).…”