Liver transplantation for HBV-related liver disease: Impact of prophylaxis for HBV on HCC recurrence.
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Burra Patrizia, Battistella Sara, Turco Laura, Morelli Maria Cristina, Frassanito Gabriella, De Maria Nicola, Pasulo Luisa, Fagiuoli Stefano, Di Benedetto Clara, Donato Maria Francesca, Magro Bianca, Pagano Duilio, Bhoori Sherrie, Mazzaferro Vincenzo, Lauterio Andrea, De Carlis Luciano, Forastiere Domenico, Rendina Maria, Angrisani Debora, Lanza Alfonso Galeota, Scandali Giulia, Svegliati Baroni Gianluca, Piano Salvatore, Angeli Paolo, Manuli Chiara, Martini Silvia, De Simone Paolo, Vacca Pier Giuseppe, Ghinolfi Davide, Lionetti Raffaella, Giannelli Valerio, Mameli Laura, Fornasiere Ezio, Toniutto Pierluigi, Biolato Marco, Ponziani Francesca Romana, Lenci Ilaria, Ferrarese Alberto, Passigato Nicola, Marenco Simona, Giannini Edoardo, Ferri Flaminia, Trapani Silvia, Grossi Paolo, Aghemo Alessio, Zanetto Alberto, Russo Francesco Paolo
Аннотация
METHODS: We performed a multicentric, retrospective study involving 20 Italian LT centers. All patients who underwent LT for HBV-related liver diseases between 2010 and 2021 were included. Logistic regression was used to identify predictors of HBV-R and HCC-R. Survival curves were estimated with the Kaplan-Meier method and compared with the log-rank test.
RESULTS: We included 1,205 LT recipients (60.8% with HCC). HBV prophylaxis was prescribed in 99.7% of recipients, mostly with lifelong hepatitis B immunoglobulin+nucleos(t)ide analogues (HBIG+NUCs) (83.9%). Rates of HBV-R were 2.1% and 3.1% in patients transplanted without and with HCC, respectively. Median times from LT were 60 [9.5-77.5] and 5.5 [1-13] months, respectively. Recipients on lifelong HBIG+NUCs experienced lower rates of HBV-R than those in whom HBIG was withdrawn, used only during LT, or in those who received NUCs alone (2.3% vs. 6.2% vs. 1.9% vs. 8%, respectively; p = 0.042). In recipients with HCC, HCC-R rate was 10.8% (median time from LT: 18 months). At multivariate analysis, HBV-R (odds ratio [OR] 10.329; 95% CI 3.665-29.110), Child-Pugh C (OR 3.519; 95% CI 1.305-9.484), and microvascular invasion (OR 3.088; 95% CI 1.692-5.634) were independently associated with HCC-R. Five-year survival was lower in recipients who experienced HCC-R (32.5% vs. 92.4% in those who did not; p <0.001).
CONCLUSION: In Italy, HBV prophylaxis is mostly based on lifelong HBIG+NUCs. HBV-R was rare and not associated with survival in patients transplanted for decompensated cirrhosis. In patients transplanted for HCC, HBV-R was independently associated with HCC-R. The clinical implications of these findings deserve further investigation.
IMPACT AND IMPLICATIONS: In Italy, the combination of high-barrier nucleos(t)ide analogues and hepatitis B immunoglobulins remains the most widely used regimen for antiviral prophylaxis following liver transplantation for HBV-related liver disease. Hepatitis B recurrence after liver transplantation is a rare event and not associated with reduced survival. In transplant recipients with hepatocellular carcinoma, HBV recurrence was independently associated with hepatocellular carcinoma recurrence, though this may simply reflect an epiphenomenon without any causal relationship.