title: Liver transplantation for HBV-related cirrhosis in Europe: an ELTR study on evolution and outcomes.
abstract: OBJECTIVE
  HBV-related chronic liver disease is one of the most common indications for liver transplantation (LT) in Europe. The ELTR database was used to evaluate outcomes and evolution over 20 years (01/1988 and 12/2010).
  
  
  METHODS
  HBV transplanted patients were analysed according to indication for LT: decompensated cirrhosis (HBVdec) or hepatocellular carcinoma (HBV/HCC). These groups were compared with co-infected patients HBV/HDV (HBDV), HBV/HCV (HBCV), HBV/HDV/HCV (HBDCV); n = 16,664 and with HCV patients (n = 2452) according to LT indication.
  
  
  RESULTS
  5912 patients were transplanted for HBV (78% HBVdec, 22% HBV/HCC), with HBV/HCC patients who increased from 15.8% in 1988-1995 to 29.6% in 2006-2010 (p < 0.001). In HBVdec patients, 1, 3, 5, and 10 year patient and graft survival was 83%, 78%, 75%, 68%, and 80%, 74%, 71%, 64%, respectively, significantly better than HBV/HCC (84%, 73%, 68%, 61%, and 81%, 70%, 65%, 58% respectively; p = 0.001 and p = 0.026). In 2006-2010 patient and graft survival significantly improved compared to 1988-1995, both for HBVdec and HBV/HCC (each p < 0.001). A better patient and graft survival was seen in HBV/HCC patients with HBV-DNA(-) compared to HBV-DNA(+) at the time of LT (p < 0.001). Disease recurrence, as cause of death/graft loss, was significantly reduced in recent years compared to the past: currently <1% for HBVdec and 3% for HBV/HCC.
  
  
  CONCLUSIONS
  Outcomes of LT for HBV have improved in recent years, with disease recurrence being no longer a significant cause of death/graft loss. HBV-DNA at the time of LT seems to influence survival only in HBV/HCC patients.
authors.affiliation: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy. burra@unipd.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Giacomo
authors.initials: G
authors.lastname: Germani
authors.forename: Renè
authors.initials: R
authors.lastname: Adam
authors.forename: Vincent
authors.initials: V
authors.lastname: Karam
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Franco
authors.initials: F
authors.lastname: Filipponi
authors.forename: Jurgen L
authors.initials: JL
authors.lastname: Klempnauer
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Murat
authors.initials: M
authors.lastname: Kilic
authors.forename: Luciano De
authors.initials: LD
authors.lastname: Carlis
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Francesco P
authors.initials: FP
authors.lastname: Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology; D019701:Hepatitis D, Chronic / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult