ETV is superior to LAM for preventing HBV re-infection following LT.

Aim: To analyze the relationship between hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrence in orthotopic liver transplantation (OLT) patients. Methods: 340 HBV patients with OLT were included in the study; among them were 148 patients with HBV-associated HCC. Results: HCC recurrence rates at 1, 3 and 5 years were 21, 29, and 46%, respectively. Exceeding Milan criteria (hazard ratio, HR = 12.35; 95% confidence interval, CI, 2.80–54.49; p = 0.001), HBV DNA level >5 log₁₀ copies/ml before transplant (HR = 2.45; 95% CI 1.10–5.45; p = 0.03) and HBV recurrence (HR = 2.27; 95% CI 1.10–4.75; p = 0.03) were significant independent predictors of HCC recurrence. HBV DNA >5 log₁₀ copies/ml before transplant (HR = 8.65; 95% CI 3.40–21.98; p < 0.001) and concomitance with HCC (HR = 2.79; 95% CI 1.33–5.87; p = 0.007) were predictors of HBV recurrence. Further stratified analysis showed that HBV recurrence was more prevalent in the HCC recurrence group (HR = 4.58; 95% CI 1.88–11.12; p = 0.001). Conclusions: There is a close relationship between HBV and HCC recurrence after transplant. High HBV DNA levels before transplant are associated with HCC recurrence after transplant.

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Introduction: Orthotopic liver transplantation (OLT) in patients with hepatitis B virus (HBV) infection used to be controversial for the high HBV recurrence rate without effective prophylactic therapy, following by a high rate of graft loss and poor survival. Most liver transplantation centers now have adopted low dosed hepatitis B immunoglobulin (HBIG) and nucleoside analogues considering its effective and economical prophylaxis. However, the risk factors haven't been re-evaluated under this combined therapy. We aimed to investigate the risk factors and long-term prognosis of HBV recurrence after OLT under prophylaxis of combined low dosed HBIG and nucleoside analogues. Methods: 340 HBV patients with OLT underwent from Jan 2004 to Dec 2008 were included in this study. All patients were regularly followed up at the outpatient clinic and received immunoprophylaxis with nucleoside analogues and low dosed HBIG (800 IU within anhepatic phase and 400 IU daily within the first postoperative week, followed by 400 IU on demand maintaining trough serum titers of anti-HBs no less than 100 IU/L). Kaplan-Meier was performed to analyze the survival rate and incidence of HBV recurrence. COX regression analysis was used to rank the relative risk of potential variables. Results: Thirty-three patients suffered from hepatitis recurrence post transplant, with the overall recurrence rate of 9.7% (33/340). The mean HBV recurrence time was 8.4±13.2 months (2-49 months). 1-, 3-, 5-year recurrence rate was 7.0%, 10.0%, 13.0% respectively. HBIG was terminated and nucleoside analogue was modulated in 33 patients who developed HBV recurrence. Except 3 patients whose HBV DNA was between 3-5 log10 copies/mL, the other patients' HBV DNA was controlled less than 3 log10 copies/ mL. The 1-, 3-, 5-year survivals of 340 patients were 94%,84%,81%. There was no significant difference of the survival rate between HBV recurrence patients and non-HBV recurrence ones (94%, 87%, 81% vs 89%, 82%, 82%). COX regression analysis revealed that risk factors for HBV recurrence were concomitance with hepatocellular carcinoma (RR=2.98; 95% CI 1.08-8.25; P=0.035) and HBV-DNA load over 5 log10 copies/ml (RR=3.99; 95% CI 1.85-8.62; P<0.001). Further stratified analysis showed that patients who suffered from carcinoma recurrence had a higher incidence of HBV recurrence than those who did not, which was 27.9% and 8.7% respectively (HR=4.58;95% CI 1.88-11.12; P=0.001). Conclusion: The risk factors for HBV recurrence are concomitance with hepatocellular carcinoma and HBV-DNA load > 5 log10 copies/ml. HBV recurrence is not the main cause of graft loss and death under the prophylaxis of combined nucleoside analogues and low dosed HBIG.