title: Liver transplantation for hepatitis B virus: Decreasing indication and changing trends.
abstract: OBJECTIVE
  To evaluate the indication and outcome of hepatitis B virus (HBV)-related liver transplantation (LT) in the era of newer antiviral agents.
  
  
  METHODS
  We collected data on all patients who underwent transplantation at King Faisal Specialist Hospital and Research Center. These data included demographic, perioperative and long-term postoperative follow-up data including viral serological markers, HBV DNA, and repeated liver imaging. Between January 1990 and January 2012, 133 patients (106 males and 27 females) underwent LT for HBV-related cirrhosis at our center. All patients were followed up frequently during the first year following transplantation, according to our standard protocol; follow-up visits occurred every 3-6 mo thereafter. Breakthrough infection was defined as re-emergence of HBV-DNA or hepatitis B surface antigen (HBsAg) while on treatment. Five patients transplanted prior to 1992 did not receive immediate posttransplant anti-HBV prophylaxis; all other patients were treated with HBIG and at least one nucleos(t)ide analog.
  
  
  RESULTS
  One hundred and thirty-three patients underwent LT for HBV and were followed for a median of 82 mo (range: 1-274). The rates of post-LT survival and HBV recurrence during the follow-up period were 89% and 11%, respectively. The following factors were associated with disease recurrence: younger age (44.3 ± 16.2 years vs 51.4 ± 9.9 years, P = 0.02), positive pretransplant hepatitis B e antigen (HBeAg) (60% vs 14%, P < 0.0001), detectable pretransplant HBV DNA (60% vs 27%, P = 0.03), positive posttransplant HBsAg (80% vs 4%, P < 0.0001) and positive posttransplant HBeAg (27% vs 1%, P < 0.0001). Forty-four (33%) patients had hepatocellular carcinoma (HCC). In the first (pre-2007) group, HBV was the second leading indication for LT after hepatitis C virus infection. A total of 64 transplants were performed, including 46 (72%) for decompensated HBV cirrhosis, 12 (19%) for decompensated cirrhosis complicated by HCC and 6 (10%) for compensated cirrhosis complicated by HCC. In the second group, nonalcoholic steatohepatitis surpassed HBV as the second leading indication for LT. A total of 69 HBV related transplants were performed, including 43 (62%) for decompensated HBV cirrhosis, 7 (10%) for decompensated cirrhosis complicated by HCC and 19 (27.5%) for compensated cirrhosis complicated by HCC. There was a significant (P = 0.007) increase in the number of transplants for compensated cirrhosis complicated by HCC.
  
  
  CONCLUSIONS
  The use of potent anti-HBV agents has led to a changing trend in the indications for LT. HBV is currently the third leading indication for LT in this hyperendemic area.
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Al-Hamoudi
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Hussien
authors.initials: H
authors.lastname: Elsiesy
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Bendahmash
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Nasser
authors.initials: N
authors.lastname: Al-Masri
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Safiyya
authors.initials: S
authors.lastname: Ali
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Naglaa
authors.initials: N
authors.lastname: Allam
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Sofayan
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Hamad
authors.initials: H
authors.lastname: Al Bahili
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Sebayel
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Dieter
authors.initials: D
authors.lastname: Broering
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Waleed Al-hamoudi, Abdurahman Bendahmash, Safiyya Ali, Gastroenterology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D018450:Disease Progression; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers
keywords: Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Liver transplantation; Non-alcoholic steatohepatitis