American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025
Liver transplantation for hepatitis D virus/hepatitis B virus coinfection in Italy: An intention-to-treat analysis of long-term outcomes.
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Angelico Roberta, Trapani Silvia, Manzia Tommaso Maria, Lenci Ilaria, Grossi Paolo, Ricci Andrea, Burra Patrizia, Andorno Enzo, Agnes Salvatore, Bhoori Sherrie, Baccarani Umberto, Belli Luca S, Carrai Paola, Caccamo Lucio, Carraro Amedeo, Cescon Matteo, Colledan Michele, Cillo Umberto, De Carlis Luciano, De Maria Nicola, De Simone Paolo, di Benedetto Fabrizio, Donato Maria Francesca, Maria Ettorre Giuseppe, Ferri Flaminia, Lanza Alfonso Galeota, Ghinolfi Davide, Grieco Antonio, Gruttadauria Salvatore, Marenco Simona, Martini Silvia, Mazzaferro Vincenzo, Pellicelli Adriano, Pinelli Domenico, Rendina Maria, Rizzetto Mario, Romagnoli Renato, Rossi Massimo, Russo Francesco Paolo, Schiadà Laura, Tandoi Francesco, Toniutto Pierluigi, Turco Laura, Vennarecci Giovanni, Viganò Mauro, Vivarelli Marco, Tisone Giuseppe, Feltrin Giuseppe, Nardi Alessandra, Angelico Mario
Аннотация
Patients with hepatitis D virus (HDV)/hepatitis B virus (HBV)-related end-stage liver disease candidates for liver transplantation (LT) have traditionally been regarded as a special population, although their outcomes are controversial. An intention-to-treat (ITT) analysis of long-term outcomes of HDV/HBV-coinfected patients waitlisted for LT in Italy, between 2011 and 2020, was performed and compared with HBV-monoinfected LT candidates. Of 1731 HBV-infected LT candidates, 1237 (71.5%) had HBV monoinfection and 494 (28.5%) HDV/HBV coinfection. At listing, HDV/HBV-coinfected patients were significantly younger, listed mainly for decompensated cirrhosis, and with fewer hepatocellular carcinoma (HCC) cases; (26% vs 65.8%; P <.0001) compared with HBV-monoinfected patients. HDV/HBV-coinfected patients showed better 5-year ITT survival (83.2%; 95% CI: 79.4%-83.4%, vs 71.6%; 95% CI: 68.8%-74.2%; P < .0001). ITT-multivariable analysis identified the presence of HCC, advanced recipient age, and high model for end-stage liver disease-Na scores as mortality risk factors. Five years after LT, 99.1% of HDV/HBV-coinfected patients received oral nucleos(t)ide analogs, with immunoglobulins against antigen of the hepatitis B virus in 91.8% of cases. HBV and HDV viral recurrences were 1.1% and 0.2%, respectively, whereas recurrent or de novo HCC were 8.9% and 0.3%, respectively. In Italy, HDV/HBV-coinfected patients waitlisted for LT showed more favorable outcomes compared with HBV-monoinfected patients, both before and after LT. These excellent results, from the largest cohort reported so far, suggest that HDV/HBV-coinfected LT recipients do not represent a risky population and may be considered for simpler long-term antiviral prophylactic strategies.