Long-term clinical and virological outcome after liver transplantation for cirrhosis caused by chronic delta hepatitis.
Liver transplantation for liver diseases related to hepatitis B virus (HBV) and hepatitis delta virus (HDV) remains problematic because of the risk of viral recurrence. We report here the long-term virological outcome of patients transplanted for HDV-related liver cirrhosis (HDV cirrhosis). From December 1984 to December 1990, 76 patients with HDV cirrhosis underwent liver transplantation. Before transplantation, all the patients were HBsAg-positive/anti-HDV positive, and all but one were HBV DNA-negative by dot blot hybridization. HDV RNA was detected by HDV RT-PCR and liver HDAg by fluorescent HDV Ab. After transplantation, all the patients except four received continuous long-term anti-HBs passive immunoprophylaxis. The actuarial 5-year survival was 88%. All patients who did not receive anti-HBs immunoprophylaxis remained HBsAg-positive and developed hepatitis. Among the 68 patients receiving antiHBs immunoprophylaxis with a minimum follow-up of 2 months, HBsAg reappeared in 7 (10.3%) after a mean of 17 months. These seven patients developed hepatitis, with simultaneous HBV and HDV replication; and four cleared later HBsAg. Patients without HBV reinfection were studied for HDV reinfection: liver HD Ag or serum HDV RNA were present in 88% of the patients during the first year, without developing hepatitis; however, they were no longer detectable after 2 years in 95% of the patients. In conclusion, liver transplantation for HDV cirrhosis gives good results, with a 5-year actuarial survival of 88%.(ABSTRACT TRUNCATED AT 250 WORDS)
Samuel
D
D
Hepatobiliary Surgery and Liver Transplant Research Unit, Paul Brousse Hospital, Villejuif, France.
Zignego
A L
AL
Reynes
M
M
Feray
C
C
Arulnaden
J L
JL
David
M F
MF
Gigou
M
M
Bismuth
A
A
Mathieu
D
D
Gentilini
P
P
D000206:Actuarial Analysis; D000328:Adult; D002908:Chronic Disease; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000628:therapy; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D003699:Hepatitis D / Q000150:complications* / Q000628:therapy; D003698:Hepatitis Delta Virus / Q000235:genetics; D006801:Humans; D016219:Immunotherapy, Adoptive; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral