Live-donor liver transplantation for acute-on-chronic hepatitis B liver failure.
BACKGROUND
The survival results of patients demonstrating acute-on-chronic liver failure and undergoing live-donor liver transplantation (LDLT) have been reported to be poor. This study evaluates the survival outcomes of patients who underwent LDLT using right-lobe liver grafts for acute-on-chronic hepatitis B liver failure.


METHODS
The study comprised 32 patients who demonstrated acute-on-chronic hepatitis B liver failure with mean (+/- standard error of mean) Model for End-Stage Liver Disease scores of 36+/-1.8. The mean preoperative intensive care unit stay was 2.4 days. LDLT using a right-lobe liver graft including the middle hepatic vein was performed in all patients. Oral lamivudine 100 mg daily was used for hepatitis B prophylaxis.


RESULTS
The patients received liver grafts that were 52%+/-2% of the estimated standard liver weight. Hospital mortality occurred in two patients, and two other patients died on follow-up. At a median follow-up of 23 months, both patient and graft survival rates were 88%. The survival results were not different from those of 49 patients who underwent right-lobe LDLT for elective conditions during the same study period (graft survival=82%, P=0.55; patient survival=84%, P=0.75). Two (6.3%) patients developed hepatitis B virus DNA breakthrough 47 and 53 months, respectively, after transplantation, but they remained well after treatment with adefovir.


CONCLUSIONS
Right-lobe LDLT is an effective therapeutic option for patients with acute-on-chronic hepatitis B liver failure. It results in satisfactory survival outcomes comparable to those in patients undergoing LDLT for elective conditions.
Liu
Chi-Leung
CL
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. clliu@hkucc.hku.hk.
Fan
Sheung-Tat
ST
Lo
Chung-Mau
CM
Wei
William Ignace
WI
Yong
Boon-Hun
BH
Lai
Ching-Lung
CL
Wong
John
J
D000208:Acute Disease; D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D017093:Liver Failure / Q000209:etiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D012189:Retrospective Studies; D016019:Survival Analysis
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; C053001:adefovir; D000225:Adenine