Long Term Outcome of Patients With Hepatitis B Infection (Genotype D) After Liver Transplantation

Abstract

Recurrent hepatitis C is characterized by a higher rate of fibrosis progression and in almost 30% of the cases lead to graft cirrhosis within 5 years Goal: 1) to investigate the rate of severe HCV recurrence after OLT based in protocol liver biopsies and 2) to investigate decompensation, retrasplantation, and survival rates after severe HCV recurrence Methods: The study included 88 patients (pts) who underwent OLT between 6/95 and 12/09. Inclusion criteria were: recurrent HCV infection after OLT (detectable HCV RNA in serum), follow up ≥ 1 year and annual protocol liver biopsies. Severe recurrence of HCV was defined as fibrosis stage ≥ to F3 in protocol biopsies performed at any time after OLT. Pts with fibrosing cholestatic hepatitis were excluded. Staging of recurrent hepatitis C was assessed with the METAVIR score. Actuarial risk analysis was investigated by Kaplan-Meier Results: based on protocol biopsies HCV recurrence was diagnosed as mild in 60 (68%) and severe in 28 (32%) pts. Mean number of biopsies analyzed were 6±2 biopsies per pts. Actuarial Risk at 1,3 and 5 yrs post OLT for fibrosis stage F3 was 8%, 27%, 32% and for F4 0%, 11% and 23% at the same time periods. Mean time interval between OLT and F3-F4 stage fibrosis was 37±26 months. 36% (10/28) of the pts with severe recurrence experienced decompentation, developing ascitis (100%), spontaneous bacterial peritonitis (30%) and encephalopathy (50%).40% developed esophageal varices, with 3 episodes of varices bleeding. Median time interval from last biopsies to decompensation was 30 (1-98) months. 50% of the pts required re transplantation and pts actuarial survival rate at 1,2,3 yrs were 100%, 71%, 47%. In pts with severe recurrence without decompensation (64%) actuarial survival rate at 1,2,3 years were 100%, 97% and 95% (P=0,0002). Conclusions: 1) Natural history of hepatitis C in inmunossupressed liver transplant recipients is characterized by an accelerated fibrogenesis 2) After 5 years of follow up the actuarial risk of reaching stage 3 fibrosis was 32% and of developing cirrhosis 23% 3) Prevalence of decompensation after severe recurrence was 36% with decrease survival overtime, although the higher rate of retransplantation Disclosure: All authors have declared no conflicts of interest.Inroduction:The use of hepatitis B immunoglobulin (HBIg) and lamivudine resulted in a significant reduction in hepatitis B virus (HBV) recurrence following liver transplantation (LT). The aim of this study was (a) to evaluate the use of lamivudine and/or adefovir in combination with long term intravenous HBIg in preventing disease recurrence and (b) to evaluate the HBV serological markers following LT. METHODS: 111 patients who received a liver transplantation for HBV related cirrhosis and were followed in our center from Jan 1990 to December 2009 were included. With the exception of four patients (transplanted prior to 1993) all patients received combination therapy with nucleos(t)ide analogue and HBIg . Breakthrough infection was defined as a re-emergence of HBVD...