Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2026
Hepatitis B Virus Recurrence After Liver Transplant for Hepatitis B Virus-Related Liver Disease: A Retrospective Analysis of Hepatitis B Immunoglobulin Discontinuation.
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Aktuna Hakan, Daniş Nilay, Döngelli Hüseyin, Bacakoğlu Aylin, Ünek Tarkan, Avkan Oğuz Vildan, Egeli Tufan, Ağalar Cihan, Özbilgin Mücahit, Akarsu Mesut
Аннотация
OBJECTIVES: Hepatitis B virus recurrence after liver transplant remains a clinically relevant issue, but the optimal duration and safety of hepatitis B immunoglobulin therapy, particularly its discontinuation, remain unclear. Here, we evaluated the incidence and risk factors of posttransplant hepatitis B virus recurrence and assessed outcomes following elective discontinuation of hepatitis B immunoglobulin in a real-world cohort.
MATERIALS AND METHODS: We conducted a retrospective single-center cohort study of consecutive adult patients who underwent liver transplant for hepatitis B virus-related liver disease between 1997 and 2023. Hepatitis B virus recurrence was defined as the reappearance of hepatitis B surface antigen and/or detectable hepatitis B virus DNA. We used Cox proportional hazards models to identify factors associated with recurrence and overall survival. We conducted a predefined subgroup analysis to evaluate patients who underwent elective discontinuation of hepatitis B immunoglobulin during antiviral therapy.
RESULTS: Among 254 liver transplant recipients, 39 (15.4% ) developed posttransplant hepatitis B virus recurrence. In multivariable analysis, pretransplant hepatitis B virus DNA levels >5 log10 copies/mL (hazard ratio 3.68; 95% CI, 1.82-7.46) and hepato-cellular carcinoma at transplant (hazard ratio 2.38; 95% CI, 1.22-4.65) were independently associated with recurrence, whereas hepatitis D virus coinfection was inversely associated (hazard ratio 0.18; 95% CI, 0.08-0.43). Elective hepatitis B immunoglobulin discontinuation was not associated with increased hepatitis B virus recurrence and was primarily performed in clinically selected low-risk patients. Posttransplant hepatitis B virus recurrence was associated with reduced overall survival.
CONCLUSIONS: In this long-term, real-world cohort, posttransplant hepatitis B virus recurrence was mainly driven by the pretransplant viral burden and oncological factors. Elective hepatitis B immunoglobulin discontinuation in carefully selected patients was not associated with increased recurrence, likely reflecting the underlying risk stratification rather than a causal protective effect. These findings support the use of individualized risk-based hepatitis B immunoglobulin strategies after liver transplant.
MATERIALS AND METHODS: We conducted a retrospective single-center cohort study of consecutive adult patients who underwent liver transplant for hepatitis B virus-related liver disease between 1997 and 2023. Hepatitis B virus recurrence was defined as the reappearance of hepatitis B surface antigen and/or detectable hepatitis B virus DNA. We used Cox proportional hazards models to identify factors associated with recurrence and overall survival. We conducted a predefined subgroup analysis to evaluate patients who underwent elective discontinuation of hepatitis B immunoglobulin during antiviral therapy.
RESULTS: Among 254 liver transplant recipients, 39 (15.4% ) developed posttransplant hepatitis B virus recurrence. In multivariable analysis, pretransplant hepatitis B virus DNA levels >5 log10 copies/mL (hazard ratio 3.68; 95% CI, 1.82-7.46) and hepato-cellular carcinoma at transplant (hazard ratio 2.38; 95% CI, 1.22-4.65) were independently associated with recurrence, whereas hepatitis D virus coinfection was inversely associated (hazard ratio 0.18; 95% CI, 0.08-0.43). Elective hepatitis B immunoglobulin discontinuation was not associated with increased hepatitis B virus recurrence and was primarily performed in clinically selected low-risk patients. Posttransplant hepatitis B virus recurrence was associated with reduced overall survival.
CONCLUSIONS: In this long-term, real-world cohort, posttransplant hepatitis B virus recurrence was mainly driven by the pretransplant viral burden and oncological factors. Elective hepatitis B immunoglobulin discontinuation in carefully selected patients was not associated with increased recurrence, likely reflecting the underlying risk stratification rather than a causal protective effect. These findings support the use of individualized risk-based hepatitis B immunoglobulin strategies after liver transplant.