Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease.
OBJECTIVE
To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT.


METHODS
Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBV-DNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis (CH) B after LT was classified as minimal, mild, moderate or severe.


RESULTS
HBV recurred in 7/42 (16.6%) patients after 6-96 mo of follow-up. A hundred and eighty-seven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg+/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients (7.1%), minimal/non-specific changes were observed in 18 (64.2%), and at least 1 biopsy showed CH in the remaining 8 (28.5%). Twenty-nine LB obtained from 7 patients transplanted for HBV-HCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg+ or HBsAg- liver diseases.


CONCLUSIONS
Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.
Department of Surgical and Gastroenterological Sciences, Gastroenterology Section, University Hospital, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
Stefano
S
Targhetta
Federico
F
Villamil
Paolo
P
Inturri
Patrizia
P
Pontisso
Stefano
S
Fagiuoli
Umberto
U
Cillo
Attilio
A
Cecchetto
Simona
S
Gianni
Remo
R
Naccarato
Patrizia
P
Burra
D001707:Biopsy, Needle / Q000379:methods; D002985:Clinical Protocols; D004279:DNA, Viral / Q000097:blood; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000175:diagnosis / Q000601:surgery*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000473:pathology*; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin