Predictive factors of outcome in patients transplanted for hepatitis B.
BACKGROUND
This study aimed to (1) identify the variables that affect graft and patient survival in recipients transplanted for hepatitis B virus (HBV) disease; and (2) assess factors associated with an increased risk of graft cirrhosis at 5 years after liver transplantation (LT).


RESULTS
A total of 104 chronically infected HBV patients were considered for this study and all received tacrolimus- or cyclosporine A (CSA)-based immunosuppressive regimens. The overall 5-year patient and graft survival rates were 80% and 73%, respectively. Univariate Cox proportional hazards regression analysis indicated that older recipient age and higher body mass index (BMI) at LT, LT more than or equal to 1998, arterial hypertension, hyperlipidemia, and CSA-based immunosuppression correlated with decreased patient survival. In the multivariate model, advanced recipient age, higher BMI, CSA-based immunosuppressive therapy, and increasing cold ischemia time were associated with worse patient survival. Recipient age and BMI at time of LT and posttransplant hypertriglyceridemia also affected graft survival. Log-rank analysis showed that a viral load of more than 10 copies/mL and antiviral therapy at LT, post-LT biliary complications, HBV recurrence, nucleos(t)ide analogue monoprophylaxis (without hepatitis B immunoglobulin), and short-term (< or = 1 year) mycophenolate mofetil therapy were significant risk factors for graft cirrhosis within 5 years of LT.


CONCLUSIONS
Various recipient factors at the time of LT and post-LT virological status, antiviral prophylaxis, cholestasis, cardiovascular risk profile, and immunosuppressive regimen affect the outcome of HBV patients after LT. Prospective studies are warranted to define optimal immunosuppression for recipients transplanted for hepatitis B.
Beckebaum
Susanne
S
Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany. susanne.beckebaum@uni-due.de
Sotiropoulos
Georgios C
GC
Klein
Christian G
CG
Broelsch
Christoph E
CE
Saner
Fuat
F
Paul
Andreas
A
Gerken
Guido
G
Cicinnati
Vito R
VR
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006509:Hepatitis B / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus; C045213:hepatitis B hyperimmune globulin