Liver transplantation for HBV-related cirrhosis in Europe: An ELTR study on evolution and outcomes

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• 作者：Patrizia Burra¹ ; ^&dagger ; ; ^{burra@unipd.it} ; Giacomo Germani¹ ; ^&dagger ; ; Renè ; Adam² ; ^&dagger ; ; Vincent Karam² ; ^&dagger ; ; Alfredo Marzano³ ; ^&dagger ; ; Pietro Lampertico⁴ ; ^&dagger ; ; Mauro Salizzoni⁵ ; ^&dagger ; ; Franco Filipponi⁶ ; ^&dagger ; ; Jurgen L. Klempnauer⁷ ; ^&dagger ; ; Denis Castaing² ; ^&dagger ; ; Murat Kilic⁸ ; ^&dagger ; ; Luciano De Carlis⁹ ; ^&dagger ; ; Peter Neuhaus¹⁰ ; ^&dagger ; ; Sezai Yilmaz¹¹ ; ^&dagger ; ; Andreas Paul¹² ; ^&dagger ; ; Antonio D. Pinna¹³ ; ^&dagger ; ; Andrew K. Burroughs¹⁴ ; ^&dagger ; ; Francesco P. Russo¹ ; ^&dagger ;
• 关键词：Liver transplantation ; Hepatitis B ; Europe
• 刊名：Journal of Hepatology
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：58
• 期：2
• 页码：287-296
• 全文大小：984 K

文摘

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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.