Risk of HBV reinfection after liver transplantation in HBsAg‐positive cirrhosis: Primary hepatocellular carcinoma is not a predictor for HBV recurrence

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Abstract
Two hundred and twenty‐eight patients who underwent orthotopic liver transplantation for hepatitis B‐related cirrhosis in 11 European Liver Transplant Centers were collected. The male/female ratio was 184/44, with a median age of 41 years (13–66). In 55 patients (24%) hepatocellular carcinoma was associated with liver disease. All cases were stratified for pre‐orthotopic liver transplantation viral characteristics: HBV‐DNA neg/HBeAg neg: 106 patients (47%), HBV‐DNA neg/Delta pos: 80 (35.5%), HBV‐DNA pos/HBeAg pos: 28 (12.5%), other 14 (5%). In 49 patients (21.4%) post‐orthotopic liver transplantation passive prophylaxis with anti‐HBs immunoglobulins was not followed, while in 179 patients the anti‐HBs serum titer was kept above 100–200 mU/ml. Overall 5‐year actuarial survival of the series was 54%. One hundred and eighty‐five patients were evaluable for HBsAg reappearance in the serum at various intervals after orthotopic liver transplantation. Overall 3‐year HBV‐free survival of these patients was 55%. There was a significant difference in 3‐year HBV‐free survival between HBV‐DNA neg (52%), HBV‐DNA pos (13%) and Delta pos (73%) patients (p: 0.03). Sixty‐three percent of patients in the prophylaxis group were HBV‐free, compared to only 25% of untreated patients (p>0.001). Three‐year HBV‐free survival in patients with or without HCC was 44% and 59%, respectively. Cox‐multivariate analysis revealed that only post‐transplantation prophylaxis (p: 0.003) and pre‐transplantation viral activity (p: 0.004) can be considered as independent factors affecting HBV recurrence. Candidates with hepatocellular carcinoma in HBV‐cirrhosis should not be excluded from orthotopic liver transplantation, supporting the idea of a higher risk of post‐transplantation viral reactivation.