TY - JOUR
T1 - Long term survival and complications after liver transplantation in patients with chronic hepatitis B
AU - Yataco, Maria
AU - Bonatti, Hugo
AU - Machicao, Victor
AU - Mendez, Julio
AU - Stauffer, John
AU - Nguyen, Justin
AU - Ghabril, Marwan
AU - Aranda-Michel, Jaime
AU - Dickson, Rolland C.
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2010
Y1 - 2010
N2 - Background: Following introduction of effective antiviral prophylaxis, recurrent hepatitis B after liver transplantation (LT) has become a rare event. Material/Methods: From 1998 to 2001, 402 patients underwent 467 LTs at our center including 24 individuals (28 LTs) with chronic hepatitis B. All patients received HBIg prophylaxis; 23 in combination with lamivudine and one (YMDD mutant) received adefovir. Results: Eleven patients (46%) had HCC (five outside the Milan criteria); only one died from tumor recurrence four years post LT. The one-year graft and patient survival were 87% and 92%, respectively. Currently 19 patients (79%) are alive with well functioning grafts (minimum follow up of >7 years). No patient developed recurrent hepatitis B; 12 currently receive lamivudine/HBIg, 3 lamivudine monotherapy, 3 discontinued antivirals. Follow up liver biopsies showed minimally active or no active hepatitis and negative HBV immunostains in all patients. Long term comorbid conditions included hypertension (77%), chronic renal failure (50%), diabetes mellitus (77%), hyperlipidemia (36%), obesity (55%), malignancies (37%) and neuropsychiatric disorders (55%). During the study period, 24 individuals (6%) were transplanted for chronic hepatitis B as opposed to only 38 individuals (3.3%) from 2002 to 6/2008 (1298 LTs in 1162 patients). Conclusions: LT for chronic HBV produced excellent long term results despite inclusion of patients with HCC outside the Milan criteria. Long term medical complications must be considered. Indication for LT for chronic HBV is declining but long term development of resistance remains a matter of concern.
AB - Background: Following introduction of effective antiviral prophylaxis, recurrent hepatitis B after liver transplantation (LT) has become a rare event. Material/Methods: From 1998 to 2001, 402 patients underwent 467 LTs at our center including 24 individuals (28 LTs) with chronic hepatitis B. All patients received HBIg prophylaxis; 23 in combination with lamivudine and one (YMDD mutant) received adefovir. Results: Eleven patients (46%) had HCC (five outside the Milan criteria); only one died from tumor recurrence four years post LT. The one-year graft and patient survival were 87% and 92%, respectively. Currently 19 patients (79%) are alive with well functioning grafts (minimum follow up of >7 years). No patient developed recurrent hepatitis B; 12 currently receive lamivudine/HBIg, 3 lamivudine monotherapy, 3 discontinued antivirals. Follow up liver biopsies showed minimally active or no active hepatitis and negative HBV immunostains in all patients. Long term comorbid conditions included hypertension (77%), chronic renal failure (50%), diabetes mellitus (77%), hyperlipidemia (36%), obesity (55%), malignancies (37%) and neuropsychiatric disorders (55%). During the study period, 24 individuals (6%) were transplanted for chronic hepatitis B as opposed to only 38 individuals (3.3%) from 2002 to 6/2008 (1298 LTs in 1162 patients). Conclusions: LT for chronic HBV produced excellent long term results despite inclusion of patients with HCC outside the Milan criteria. Long term medical complications must be considered. Indication for LT for chronic HBV is declining but long term development of resistance remains a matter of concern.
KW - HBV
KW - Hepatocellular cancer
KW - Immunosuppression
KW - Lamivudine
KW - Liver transplant
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M3 - Article
C2 - 20657516
AN - SCOPUS:77954628255
SN - 1425-9524
VL - 15
SP - 27
EP - 34
JO - Annals of Transplantation
JF - Annals of Transplantation
IS - 2
ER -