Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease.
Fifty-nine patients with prior hepatitis B virus infection underwent orthotopic liver transplantation. During the first 2 mo, mortality was not significantly different in the hepatitis B virus-infected group (25.5%) vs. a hepatitis B virus-immune control group (21%). Beyond 2 mo, the mortality, rate of graft loss, need for retransplantation and incidence of abnormal liver function were significantly higher in the hepatitis B virus-infected group. Treatment of the hepatitis B virus infection was attempted with passive immunization, combined active and passive immunization, alpha-interferon or nothing. The clinical outcome was not significantly influenced by any of these therapies. However, of the patients who lived more than 60 days, 6 of 22 treated with active plus passive immunization were cleared of HBsAg, something achieved once in 16 patients treated with alpha-interferon, never in 3 patients with passive immunization only and once in 4 patients with no therapy. In patients with recurrent hepatitis B virus infection, the pace of hepatitis development in the graft appeared to be accelerated, and this was particularly striking in patients who underwent multiple retransplantations at progressively shorter intervals. None of the patients who became HBsAg-negative had HBeAg preoperatively.
Todo
S
S
Department of Surgery, University Health Center of Pittsburgh, University of Pittsburgh, Pennsylvania 15213.
Demetris
A J
AJ
Van Thiel
D
D
Teperman
L
L
Fung
J J
JJ
Starzl
T E
TE
D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D008099:Liver / Q000503:physiopathology; D016031:Liver Transplantation / Q000401:mortality; D011184:Postoperative Period; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors
D006514:Hepatitis B Surface Antigens