title: Prophylaxis against hepatitis B virus recurrence after liver transplantation for hepatitis B virus-related end-stage liver diseases with severe hypersplenism and splenomegaly: role of splenectomy.
abstract: BACKGROUND
  The role of splenectomy on prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT) for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly remains unclear today.
  
  
  METHODS
  A total of 510 consecutive patients with HBV-related end-stage liver diseases who underwent LT in Liver Transplantation Center, West China Hospital, Sichuan University (Chengdu, China) between June 1999 and October 2009 were studied retrospectively in this study. Patients were divided into three groups in this study: splenectomized group (group A, n=137), including preoperatively splenectomized subgroup (group A1, n=48) and intraoperatively splenectomized subgroup (group A2, n=89); nonsplenectomized group with severe hypersplenism (group B, n=95); and nonsplenectomized group without severe hypersplenism (group C, n=278). The incidence of posttransplant rejection, posttransplant infection, posttransplant hepatic cell carcinoma recurrence rate, and HBV recurrence rate were recorded. The end of the follow-up period was October 2010.
  
  
  RESULTS
  In this study, six patients with HBV recurrence were found in group A, 15 cases in group B, and 13 cases in group C during the follow-up period. (1) The incidence of posttransplant rejection in patients of group A was significantly lower than that in group B (P=0.0023) and also the HBV recurrence rates in group A markedly decreased (P=0.004). (2) The incidence of posttransplant rejection in group A was significantly lower than that in group C (P=0.0433); however, the incidence of posttransplant infection in group A largely increased compared with that in group C (P=0.0233). The HBV recurrence rates between group A and group C had no significant difference (P=0.804). (3) The HBV recurrence rates in group B were significantly higher than that in group C (P=0.001).
  
  
  CONCLUSIONS
  The results of this study showed that splenectomy could significantly reduce the incidence of posttransplant rejection and HBV recurrence rate for the patients undergoing LT for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly.
authors.affiliation: Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Lunan
authors.initials: L
authors.lastname: Yan
authors.forename: Tianfu
authors.initials: T
authors.lastname: Wen
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Jichun
authors.initials: J
authors.lastname: Zhao
authors.forename: Zheyu
authors.initials: Z
authors.lastname: Chen
authors.forename: Wentao
authors.initials: W
authors.lastname: Wang
authors.forename: Mingqing
authors.initials: M
authors.lastname: Xu
authors.forename: Jiayin
authors.initials: J
authors.lastname: Yang
authors.forename: Yonggang
authors.initials: Y
authors.lastname: Wei
authors.forename: Yukui
authors.initials: Y
authors.lastname: Ma
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D058625:End Stage Liver Disease / Q000601:surgery* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000517:prevention & control*; D006801:Humans; D006971:Hypersplenism / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013156:Splenectomy; D013163:Splenomegaly / Q000601:surgery* / Q000821:virology; D055815:Young Adult