[A clinicopathologic study on complications of orthotopic liver transplantation in 54 patients with chronic hepatitis B virus infection].
OBJECTIVE
To study the complication incidence of 54 patients with chronic HBV infection following their orthotopic liver transplantation (OLT), and factors associated with HBV recurrence and hepatocellular carcinoma (HCC) recurrence or metastasis post-OLT.


METHODS
The light-microscopic appearance of hepatic allograft biopsies in 54 patients with chronic HBV infection following OLT was examined. The related clinical data were analyzed. The incidence and occurrence time of post-OLT complications were studied. Furthermore, the relationship between recurrent type B viral hepatitis and acute rejection and the relationship among HCC recurrence/metastasis, acute rejection, the tumor diameter, and the portal vein invasion were particularly studied.


RESULTS
The frequent complications of patients with chronic HBV infection following OLT were acute rejection [38(70.4%); occurrence time: 5-365 d], chronic rejection [ 1(1.9%); occurrence time: 10.7 months],bile duct complications [24(44.4%); occurrence time: 7-940 d], HBV recurrence [7(13.0%); occurrence time: 1-540 d], HCV infection [3(5.6%); occurrence time: 60 d, 60 d, 33 months], CMV infection [8(14.8%); occurrence time: 67-90 d], and HCC recurrence or metastasis [17(31.5%); occurrence time: 2-41 months]. At the end of 1 year post-OLT, 95% of patients with post-hepatitis B cirrhosis were alive; At the end of 3 years post-OLT, 85% of patients with post-hepatitis B cirrhosis were alive. However, at the end of 1 year post-OLT, 67.6% of patients with post-hepatitis B HCC were alive; At the end of 3 years post-OLT, 50% of patients with post-hepatitis B HCC were alive. The number of acute rejection episodes in patients with recurrent HBV infection and that without recurrent HBV infection was (0.86+/-1.46) time/patient and (1.07+/-0.90) time/patient respectively(P>0.05); the number of moderate acute rejection episodes(RAI>or=score 4) in patients with recurrent HBV infection and that without recurrent HBV infection was (0.29+/-0.49) time/patient and (0.50+/-0.63) time/patient(P>0.05); Incidence of patients with >or=3 episodes of acute rejection in patient with recurrent HBV infection and that without recurrent HBV infection was 14.3% and 10.6%(P>0.05). Furthermore, the number of acute rejection episodes in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was (1.12+/-0.93) time/patient and (1.06+/-1.39) time/patient respectively(P>0.05); the number of moderate acute rejection episodes(RAI>or=score 4) in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was (0.65+/-0.79) time/patient and (0.65+/-1.06) time/patient respectively(P>0.05); Incidence of patients with >or=3 episodes of acute rejection in patient with HCC recurrence or metastasis and that without HCC recurrence or metastasis was 5.9% and 17.6% respectively(P>0.05). The tumor diameter in patients with HCC recurrence or metastasis was (6.72+/-3.40)cm, however, that in patients without HCC recurrence or metastasis was (3.55+/-2.17)cm(P=0.004 7).The incidence of Portal vein invasion in patients with HCC recurrence or metastasis and that without HCC recurrence or metastasis was 68.75% and 33.3% respectively(P=0.006).


CONCLUSIONS
There was no significant difference among HBV recurrence and acute rejection post-liver transplantation in patients with chronic HBV infection. There was no significant difference between HCC recurrence and acute rejection. The tumor diameter of patients with HCC recurrence or metastasis was significantly greater than that of no HCC recurrence or metastasis. The portal vein invasion of patients with HCC recurrence or metastasis was significantly frequent than that of no HCC recurrence or metastasis.
Pei
Fei
F
Department of Pathology, Peking University School of Basic Medical Sciences, Beijing, China. peifei@bjmu.edu.cn
Zheng
Jie
J
Du
Juan
J
Zhong
Hao-hao
HH
Yang
Jing-ping
JP
D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult