title: Association between hepatitis B and hepatocellular carcinoma recurrence in patients undergoing liver transplantation.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrences affect both patient and graft survivals post-orthotopic liver transplantation (OLT) in HBV patients with HCC. We analyzed the relationship between HBV and HCC recurrence in a large cohort of HBV-OLT patients with versus without HCC.
  
  
  METHODS
  Two hundred eighty-seven HBV patients with OLT (72 also with HCC) were included in the study. Mean follow-up in the post-OLT period was 31.7 +/- 24.7 (range, 3-119) months.
  
  
  RESULTS
  Post-OLT HBV recurrence observed in 10.1% of patients was more prevalent among the HCC group; 23.6% versus 5.5% in patients with and without HCC, respectively. The mean interval for the development of HBV recurrence was 39.5 +/- 28.5 (range, 2-99) months. Among 72 HCC patients, 8 patients (11.1%) had recurrent HCC, and 7 of them also had HBV recurrence. The mean interval for the development of HCC recurrence was 11.2 +/- 7.85 (range, 2-23) months after OLT. OLT patients with HCC with tumors exceeding the Milan criteria had worse 1-, 3-, and 5-year survival rates than patients with HCC meeting the Milan criteria. HBV and HCC recurrence-free survivals were significantly lower in patients with HCC and HBV recurrence, respectively. In the 7 patients with both HCC and HBV recurrence, mean HBV recurrence time was 9.42 +/- 6.75 months and mean HCC recurrence time was 9.57 +/- 6.75 months. There was a strong correlation between HBV and HCC recurrence times. Cox proportional hazards regression analysis showed that only HCC recurrence was a significant independent predictor of HBV recurrence (P < .001; hazard ratio [HR] = 26.94; 95% confidence interval [CI] = 10.81-67.11). On the other hand, HBV recurrence (P = .013; HR = 5.80; 95% CI = 1.45-23.17) and nodule count (P = .014; HR = 13.08; 95% CI = 1.70-100.83) were significant predictors of HCC recurrence.
  
  
  CONCLUSIONS
  HBV and HCC recurrences demonstrate a close relationship in patients with OLT.
authors.affiliation: Ege University, Organ Transplantation Center, Izmir, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Kiyici
authors.forename: M
authors.initials: M
authors.lastname: Yilmaz
authors.forename: M
authors.initials: M
authors.lastname: Akyildiz
authors.forename: C
authors.initials: C
authors.lastname: Arikan
authors.forename: U
authors.initials: U
authors.lastname: Aydin
authors.forename: D
authors.initials: D
authors.lastname: Sigirli
authors.forename: D
authors.initials: D
authors.lastname: Nart
authors.forename: F
authors.initials: F
authors.lastname: Yilmaz
authors.forename: T
authors.initials: T
authors.lastname: Ozacar
authors.forename: Z
authors.initials: Z
authors.lastname: Karasu
authors.forename: M
authors.initials: M
authors.lastname: Kilic
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D014019:Tissue Donors