title: Liver transplantation in patients with hepatitis B virus-related hepatocellular carcinoma: the influence of viral characteristics on clinical outcome.
abstract: BACKGROUND
  Hepatitis B virus (HBV) relapse and/or hepatocellular carcinoma (HCC) recurrence remains a major concern for patients who undergo liver transplantation (LT) because of HBV-related HCC. This study investigates the correlation between HBV relapse and HCC recurrence and it explores factors that affect patient outcomes after LT.
  
  
  METHODS
  Between September 2002 and August 2009, 78 consecutive patients who underwent LT because of HBV-related HCC were enrolled in this study. Serum samples obtained before LT were assayed both for virological factors associated with HBV DNA and for genotypic characteristics of the virus. All patient clinicopathological features and virological factors were assessed further by univariate and multivariate analyses to determine prognostic factors.
  
  
  RESULTS
  During a median follow-up period of 29.4 months, 13 (16.6 %) patients experienced HCC recurrence and 18 (23.1 %) patients experienced HBV relapse. HBV relapse exhibited a close association with HCC recurrence (p = 0.004) and led to unfavorable overall survival after LT. Multivariate analysis of prognostic factors showed that the basal core promoter (BCP) mutation independently predicted a shorter survival period free from HBV relapse (p = 0.036). Moreover, with the exception of unfavorable tumor characteristics, the BCP mutation was found to be an important prognostic factor that affected HCC recurrence after LT (p = 0.042).
  
  
  CONCLUSIONS
  In this study, the HBV-BCP mutation was identified as an important predictor of post-LT clinical outcomes in patients with HBV-related HCC. Therefore, we recommend that aggressive antiviral treatment may be considered for patients associated with this risk factor.
authors.affiliation: Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ting-Jung
authors.initials: TJ
authors.lastname: Wu
authors.forename: Kun-Ming
authors.initials: KM
authors.lastname: Chan
authors.forename: Hong-Shiue
authors.initials: HS
authors.lastname: Chou
authors.forename: Chen-Fang
authors.initials: CF
authors.lastname: Lee
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Wu
authors.forename: Tse-Ching
authors.initials: TC
authors.lastname: Chen
authors.forename: Chau-Ting
authors.initials: CT
authors.lastname: Yeh
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000401:mortality / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D015996:Survival Rate; D019562:Viral Load
chemical_list: D004279:DNA, Viral