Long-term results of liver transplant in patients with chronic viral hepatitis-related liver disease in Singapore.
BACKGROUND
Liver disease from chronic hepatitis B (CHB) and C (CHC) constitutes 57 percent of adult liver transplant in Singapore. Their long-term results post-transplant may be affected by recurrence of the viral illness. This study aims to evaluate the long-term results and survival in patients transplanted for CHB- and CHC-related liver disease.


METHODS
Patients transplanted for CHB- and CHC-related disease from 1990 until March 2004, which included decompensated cirrhosis and hepatocellular carcinoma (HCC), were reviewed and analysed.


RESULTS
25 patients were transplanted for CHB-related liver disease, with mean follow-up of 153 +/- 25 weeks. Two- and four-year survival rates were 75 percent and 69 percent, respectively. Hepatitis B recurrence from YMDD mutants occurred in five patients, and four were treated successfully with adefovir dipivoxil, with resolution in transaminases and/or improvement in histology. One patient became non-compliant with follow-up and medications, and died 173 weeks post-transplant from reactivation of the wild-type hepatitis B virus. Nine patients were transplanted for CHC-related liver disease, with mean follow-up of 188 +/- 40 weeks, and two- and four-year survival rates of 89 percent and 76 percent, respectively. Two patients developed hepatitis C recurrence and were treated with interferon and ribavarin. One responded with sustained response but the other remained viraemic and died of HCC recurrence two years post-transplant.


CONCLUSIONS
Long-term results from CHB- and CHC-related liver diseases were satisfactory and comparable to major transplant centres in the USA and Europe. Recurrence of viral hepatitis post-transplant is controllable with current antiviral therapy.
Wai
C T
CT
Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
Da Costa
M
M
Sutedja
D
D
Lee
Y M
YM
Lee
K H
KH
Tan
K C
KC
Isaac
J
J
Wee
A
A
Prabhakaran
K
K
Lim
S G
SG
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery; D005500:Follow-Up Studies; D006521:Hepatitis, Chronic / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention
D000998:Antiviral Agents