title: Extended survival of patients with persistently suppressed hepatitis B transplanted for hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) has become a major cause of liver-related death and indication to liver transplantation (LT) in patients with chronic hepatitis B virus (HBV) infection following the widespread adoption of antiviral therapy with nucleos(t)ide analogs (NUCs). Yet, the long-term outcome of patients undergoing liver transplantation for an HCC developed during effective NUC treatment is unknown.
  
  
  METHODS
  We evaluated 101 patients with persistently compensated cirrhosis who were consecutively transplanted for HCC in two centers in Milan. At LT, 91 (90%) patients had undetectable serum HBV DNA (<12 IU/ml) and 90 (89%) were within Milan criteria (MC). All patients received post-transplant HBV prophylaxis with specific immunoglobulins (HBIgs) and NUCs. End-points were long-term patient survival and recurrence of HCC and HBV.
  
  
  RESULTS
  During 106 (range 3-165) months following LT, HCC recurred in 11 (11%) patients (nine beyond MC at explant, two with HBV recurrence). Age (HR 1.1, 95%CI 1.0-1.2, P = 0.04) and exceeding MC (HR 9.6, 95%CI 2.9-32, P < 0.0001) were the only independent pretransplant predictors of tumour recurrence. The 10-year cumulative rate of HCC recurrence was 7% among patients transplanted within MC compared with 45% among those beyond MC at LT (P = 0.004). Overall, 18 patients (18%, nine HCC, nine non liver-related events) died with a 10-year cumulative probability of overall and liver-related survival of 79% and 89% respectively.
  
  
  CONCLUSIONS
  Extended survival of HBV cirrhotics transplanted for HCC can be achieved by coupling MC at listing with persistent pharmacological suppression of HBV.
authors: Hepatology Division, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
authors: Mauro
authors: M
authors: Viganò
authors: Gastroenterology and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors: Sherrie
authors: S
authors: Bhoori
authors: Gastroenterology Unit, "A. M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: Pietro
authors: P
authors: Lampertico
authors: Gastroenterology Unit, "A. M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: Maria Francesca
authors: MF
authors: Donato
authors: Gastroenterology Unit, "A. M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: Massimo
authors: M
authors: Iavarone
authors: Gastroenterology and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors: Glenda
authors: G
authors: Grossi
authors: Gastroenterology and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors: Antonio
authors: A
authors: Facciorusso
authors: Liver Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors: Lucio
authors: L
authors: Caccamo
authors: Liver Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors: Giorgio
authors: G
authors: Rossi
authors: Gastroenterology Unit, "A. M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: Massimo
authors: M
authors: Colombo
authors: Gastroenterology and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors: Vincenzo
authors: V
authors: Mazzaferro
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy*; D006515:Hepatitis B virus; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000401:mortality* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins
keywords: HBV; HCC; hepatitis B immunoglobulin; liver transplantation; nucleos(t)ide analogs