Extended survival of patients with persistently suppressed hepatitis B transplanted for hepatocellular carcinoma. (21st April 2015)

• Record Type: Journal Article
• Authors: Viganò, Mauro; Bhoori, Sherrie; Lampertico, Pietro; Donato, Maria Francesca; Iavarone, Massimo; Grossi, Glenda; Facciorusso, Antonio; Caccamo, Lucio; Rossi, Giorgio; Colombo, Massimo; Mazzaferro, Vincenzo
• Is Part Of: Liver international. Volume 35:Number 9(2015:Sep.)
• Page Start: 2187
• Page End: 2193
• Publication Date: 2015-04-21
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12835
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12835-abs-0001"> <title>Abstract</title> <sec id="liv12835-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>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.</p> </sec> <sec id="liv12835-sec-0002" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="liv12835-sec-0003" sec-type="section"> <title>Results</title> <p>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, <italic>P</italic> = 0.04) and exceeding MC (HR 9.6, 95%CI 2.9–32, <italic>P</italic> < 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 (<italic>P</italic> = 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.</p> </sec> <sec id="liv12835-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Extended survival of HBV cirrhotics transplanted for HCC can be achieved by coupling MC at listing with persistent pharmacological suppression of HBV.</p> </sec> </abstract>