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Conference Paper: Long-term outcomes of persistently positive hepatitis B surface antigen after liver transplantation for chronic hepatitis B

TitleLong-term outcomes of persistently positive hepatitis B surface antigen after liver transplantation for chronic hepatitis B
Authors
Issue Date2020
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/jhep
Citation
Digital International Liver Congress (Digital ILC 2020), 27-29 August 2020. In Journal of Hepatology, 2020, v. 73 n. Suppl. 1, p. S265-S266 How to Cite?
AbstractBackground and Aims: Antiviral therapy alone without hepatitis B immune globulin (HBIG) has been shown to be effective after liver transplantation for chronic hepatitis B (CHB). However, a small proportion will have persistently positive hepatitis B surface antigen (HBsAg), of which the long-term outcome is unclear. We aim to determine the long-term outcome of recipients with persistently positive HBsAg. Method: Consecutive patients with CHB and liver transplantation from January 2003 to December 2017 were considered. All patients received HBIG-free regimen as prophylaxis with oral antiviral therapy alone. Graft survival and outcome were determined. Results: A total of 630 CHB patients were transplanted, of which 582 (92%) had over one year of follow-up and were included. Of these, 486 (84%) were male, and 250 (43%), 212 (36%), and 120 (21%) were transplanted for decompensated cirrhosis, hepatocellular carcinoma (HCC), and severe flares respectively. The median follow-up was 104 months (range, 13–199). Forty-one (7%) had persistently positive HBsAg without evidence of seroclearance, with higher rates observed in severe flares compared to cirrhosis and HCC patients (13.3% vs. 6.8% vs. 3.8% respectively, p = 0.005). The graft survival for persistently positive HBsAg was 81.9%, 76.1% and 76.1% at 5, 10, and 15 years post-transplant respectively, compared to 93.1%, 85.3% and 77.3% respectively for those patients that were not persistently positive for HBsAg (p = 0.205), as shown in the figure. There were 9 graft losses during the follow up period for persistently positive HBsAg patients, of which 4 were due to HCC recurrence, 2 from lymphoma, 2 from extra-hepatic malignancies, and 1 from sepsis. There were no cases of graft loss due to de novo HCC or reactivation of hepatitis B virus infection. At the time of last follow-up, all active patients had undetectable HBV DNA. Conclusion: Despite a persistently positive HBsAg after liver transplantation for CHB in patients receiving HBIG-free prophylaxis, there was excellent long-term graft survival, which was comparable to patients who had evidence of HBsAg loss. Importantly, there was no graft loss from de novo HCC or hepatitis B reactivation in persistently positive HBsAg patients.
DescriptionPoster presentation - Liver transplantation and hepatobiliary surgery: Clinical aspects - no. THU254
Persistent Identifierhttp://hdl.handle.net/10722/290215
ISSN
2019 Impact Factor: 20.582
2015 SCImago Journal Rankings: 4.570

 

DC FieldValueLanguage
dc.contributor.authorFung, JYY-
dc.contributor.authorChan, ACY-
dc.contributor.authorWong, CLT-
dc.contributor.authorDai, WC-
dc.contributor.authorSin, SL-
dc.contributor.authorMak, LY-
dc.contributor.authorSeto, WKW-
dc.contributor.authorYuen, RMF-
dc.contributor.authorLo, CM-
dc.date.accessioned2020-10-22T08:23:39Z-
dc.date.available2020-10-22T08:23:39Z-
dc.date.issued2020-
dc.identifier.citationDigital International Liver Congress (Digital ILC 2020), 27-29 August 2020. In Journal of Hepatology, 2020, v. 73 n. Suppl. 1, p. S265-S266-
dc.identifier.issn0168-8278-
dc.identifier.urihttp://hdl.handle.net/10722/290215-
dc.descriptionPoster presentation - Liver transplantation and hepatobiliary surgery: Clinical aspects - no. THU254-
dc.description.abstractBackground and Aims: Antiviral therapy alone without hepatitis B immune globulin (HBIG) has been shown to be effective after liver transplantation for chronic hepatitis B (CHB). However, a small proportion will have persistently positive hepatitis B surface antigen (HBsAg), of which the long-term outcome is unclear. We aim to determine the long-term outcome of recipients with persistently positive HBsAg. Method: Consecutive patients with CHB and liver transplantation from January 2003 to December 2017 were considered. All patients received HBIG-free regimen as prophylaxis with oral antiviral therapy alone. Graft survival and outcome were determined. Results: A total of 630 CHB patients were transplanted, of which 582 (92%) had over one year of follow-up and were included. Of these, 486 (84%) were male, and 250 (43%), 212 (36%), and 120 (21%) were transplanted for decompensated cirrhosis, hepatocellular carcinoma (HCC), and severe flares respectively. The median follow-up was 104 months (range, 13–199). Forty-one (7%) had persistently positive HBsAg without evidence of seroclearance, with higher rates observed in severe flares compared to cirrhosis and HCC patients (13.3% vs. 6.8% vs. 3.8% respectively, p = 0.005). The graft survival for persistently positive HBsAg was 81.9%, 76.1% and 76.1% at 5, 10, and 15 years post-transplant respectively, compared to 93.1%, 85.3% and 77.3% respectively for those patients that were not persistently positive for HBsAg (p = 0.205), as shown in the figure. There were 9 graft losses during the follow up period for persistently positive HBsAg patients, of which 4 were due to HCC recurrence, 2 from lymphoma, 2 from extra-hepatic malignancies, and 1 from sepsis. There were no cases of graft loss due to de novo HCC or reactivation of hepatitis B virus infection. At the time of last follow-up, all active patients had undetectable HBV DNA. Conclusion: Despite a persistently positive HBsAg after liver transplantation for CHB in patients receiving HBIG-free prophylaxis, there was excellent long-term graft survival, which was comparable to patients who had evidence of HBsAg loss. Importantly, there was no graft loss from de novo HCC or hepatitis B reactivation in persistently positive HBsAg patients.-
dc.languageeng-
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/jhep-
dc.relation.ispartofJournal of Hepatology-
dc.relation.ispartofDigital International Liver Congress (Digital ILC 2020)-
dc.titleLong-term outcomes of persistently positive hepatitis B surface antigen after liver transplantation for chronic hepatitis B-
dc.typeConference_Paper-
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailWong, CLT: wongtcl@hku.hk-
dc.identifier.emailDai, WC: daiwc@HKUCC-COM.hku.hk-
dc.identifier.emailMak, LY: lungyi@hku.hk-
dc.identifier.emailSeto, WKW: wkseto@hku.hk-
dc.identifier.emailYuen, RMF: mfyuen@hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityWong, CLT=rp01679-
dc.identifier.authorityMak, LY=rp02668-
dc.identifier.authoritySeto, WKW=rp01659-
dc.identifier.authorityYuen, RMF=rp00479-
dc.identifier.authorityLo, CM=rp00412-
dc.description.natureabstract-
dc.identifier.doi10.1016/S0168-8278(20)31034-5-
dc.identifier.hkuros315876-
dc.identifier.volume73-
dc.identifier.issueSuppl. 1-
dc.identifier.spageS265-
dc.identifier.epageS266-
dc.publisher.placeNetherlands-

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