title: Does pre-liver transplant HBV DNA level affect HBV recurrence or survival in liver transplant recipients receiving HBIg and nucleos(t)ide analogues?
abstract: OBJECTIVE
  The risk of recurrent hepatitis B virus (HBV) infection and prognosis of liver transplantation in patients with HBV has dramatically changed with the use of prophylaxis including hepatitis B immune globulin (HBIg) and antiviral agents.
  
  
  METHODS
  This study analyzes the prognostic value of HBV DNA level before orthotopic liver transplantation (OLT) and the effect of HBV prophylaxis on rates of HBV recurrence and survival. Between 1988 and 2008, 859 patients underwent OLT in our center; 60 patients had HBV-related liver disease and in 49, HBV DNA was determined by real time-PCR before OLT. Survival and HBV recurrence were analyzed according to preoperative viral load (HBV DNA <10(3) IU/mL vs. HBV DNA ≥10(3)) and prophylaxis regimens (HBIg vs HBIg and antivirals).
  
  
  RESULTS
  On multivariate analysis, prophylaxis with HBIg alone, but not HBV-DNA levels was independently associated with poor survival, with a relative risk (RR) of death of 6.5 (95% CI 2.1-19.8, P = 0.001). The risk of HBV recurrence, in this small series, was also associated with monoprophylaxis with HBIg (RR 27, 95% CI 5.2-147.2, P < 0.0001), but not with HBV-DNA levels.
  
  
  CONCLUSIONS
  When prophylaxis with HBIg and antiviral agents was administered, survival and HBV recurrence were not influenced by HBV-DNA levels determined by real time-PCR prior to OLT.
authors.affiliation: Liver Unit, Department of Internal Medicine, Hospital Universitario Vall d' Hebron, Barcelona, Spain. icampos@vhebron.net
authors.forename: Isabel
authors.initials: I
authors.lastname: Campos-Varela
authors.forename: Lluís
authors.initials: L
authors.lastname: Castells
authors.forename: María
authors.initials: M
authors.lastname: Buti
authors.forename: Víctor
authors.initials: V
authors.lastname: Vargas
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodríguez-Frías
authors.forename: Rosendo
authors.initials: R
authors.lastname: Jardí
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
authors.forename: Jaime
authors.initials: J
authors.lastname: Guardia
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D017093:Liver Failure / Q000401:mortality / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009705:Nucleosides / Q000008:administration & dosage; D009711:Nucleotides / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012008:Recurrence; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D016019:Survival Analysis; D019562:Viral Load / Q000706:statistics & numerical data
chemical_list: D004279:DNA, Viral; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D009705:Nucleosides; D009711:Nucleotides; C045213:hepatitis B hyperimmune globulin