Epidemiology

Outcomes of liver transplantation for hepatitis B improving

Last Updated: 2004-08-18 15:45:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Outcomes after liver transplantation for hepatitis B have improved markedly since the introduction of hepatitis B immune globulin (HBIG) and lamivudine, according to a report in the August issue of Liver Transplantation.

Before 1990, the high frequency of disease recurrence after transplantation for hepatitis B-related liver disease made it a contraindication for liver transplantation, the authors explain. Whether outcomes on a national scale have changed since the introduction of innovative therapies in the 1990s has not been studied.

Dr. W. Ray Kim and colleagues from Mayo Clinic and Foundation, Rochester, Minnesota used data from the United Network for Organ Sharing to compare outcomes after liver transplantation for hepatitis B-related disease in the United States before (1987-1991) and after the introduction of HBIG (1992-1996) and lamivudine (1997-2002).

Before 1992, survival after liver transplantation was much shorter for hepatitis-B patients than for non-hepatitis-B patients, the authors report. Survival improved markedly after the introduction of HBIG, so that survival no longer differed between hepatitis-B and non-hepatitis-B patients.

The introduction of lamivudine brought further increases in survival, raising 1-year and 3-year survival in hepatitis-B patients (87.4% and 80.7%, respectively) above that of non-hepatitis-B patients (86.5% and 78.6%, respectively). These differences, the researchers note, did not reach statistical significance.

In a multivariable regression model, factors contributing to decreased survival after liver transplantation included earlier transplant era, advancing age, African ethnicity, the diagnosis of hepatocellular carcinoma, and increasing warm ischemic time.

"The outcome of liver transplantation for hepatitis B virus has improved significantly in the last two decades, commensurate with therapeutic innovations introduced during the period," the authors conclude. "These data underscore the importance of therapeutic innovations that have occurred incrementally in the past two decades for hepatitis B virus and support orthotopic liver transplantation as an appropriate treatment for patients with acute and chronic hepatic insufficiency or hepatocellular carcinoma from hepatitis B virus."

Liver Transpl 2004;10:968-974.