Liver transplant outcomes among HBV patients improved over time
Outcomes from liver transplantation due to hepatitis B infection improved with the emergence of new therapies, though the effect was less pronounced among women and African-Americans in a recent study.
Researchers performed a retrospective chart review to determine outcomes among 738 patients who received orthotopic liver transplantation (OLT) due to hepatitis B infection between 1985 and 1994 (era 1), 1995 and 2004 (era 2) and 2005 and 2010 (era 3). Hepatitis B immunoglobulin (HBIG) was the most prominent treatment method used during era 1, HBIG with lamivudine (LAM) during era 2 and HBIG in combination with antiviral therapy during era 3.
HBV recurrence (rHBV) occurred less frequently during eras 2 and 3 than era 1 (P<.001), with a 5-year risk of 64.8% in era 1 compared with 14% in era 3. This risk reduction was statistically significant in all evaluated ethnic groups; however, rHBV remained more frequent among African-Americans than all other ethnicities (16.9% vs. 11.6%; P=.13).
Three-year survival rates were poor regardless of sex or ethnicity during era 1, but all groups, excluding African-Americans (P=.15), experienced better survival during era 3 (P<.001 for other groups). Women had lower survival than men during this time period (P=.02).
Factors significantly associated with poor survival during era 3 via multivariate analysis included female sex (HR=3.4; 95% CI, 1.6-7.3), retransplantation (HR=4.2; 95% CI, 1.4-12.9) and recurrent hepatocellular carcinoma (HCC; P<.001). Therapy with HBIG and antivirals was linked to improved survival (HR=0.1; 95% CI, 0.05-0.4), as was treatment with HBIG and LAM (HR=0.2; 95% CI, 0.1-0.7).
“Outcomes for liver transplant have improved because of combination antiviral and immunoglobulin therapy; however, women and black Americans may not have realized an equal benefit,” the researchers concluded. “There is still a significant rate of rHBV even 10 years after transplant, and this has an effect on survival after rHBV is diagnosed.
“Women, black Americans and patients with HCC should be considered at increased risk after OLT in this population. These patients should be monitored closely for rHBV.”
Disclosure: The researchers report no relevant financial disclosures.