Liver transplantation in European patients with the hepatitis B surface antigen

Background: The role of liver transplantation in patients positive for the hepatitis B surface antigen (HBsAg) is controversial because of the high rate of recurrent hepatitis B virus (HBV) infection. It has not been determined whether this risk is greater for certain patients and whether the admini...

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Autores: Samuel, Didier, Muller, Rainer, Alexander, Graeme, Fassati, Luigi, Ducot, Beatrice, Benhamou, Jean-Pierre, Bismuth, Henri, Jaurrieta Mas, Eduardo, European Concerted Action on Viral Hepatitis Study
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:1993
País:España
Recursos:Universidad de Barcelona
Repositório:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/122709
Acesso em linha:https://hdl.handle.net/2445/122709
Access Level:Acceso aberto
Palavra-chave:Trasplantament hepàtic
Hepatitis B
Virus de l'hepatitis B
Europa
Estudi de casos
Hepatic transplantation
Hepatitis B virus
Europe
Case studies
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spelling Liver transplantation in European patients with the hepatitis B surface antigenSamuel, DidierMuller, RainerAlexander, GraemeFassati, LuigiDucot, BeatriceBenhamou, Jean-PierreBismuth, HenriJaurrieta Mas, EduardoEuropean Concerted Action on Viral Hepatitis StudyTrasplantament hepàticHepatitis BVirus de l'hepatitis BEuropaEstudi de casosHepatic transplantationHepatitis BHepatitis B virusEuropeCase studiesBackground: The role of liver transplantation in patients positive for the hepatitis B surface antigen (HBsAg) is controversial because of the high rate of recurrent hepatitis B virus (HBV) infection. It has not been determined whether this risk is greater for certain patients and whether the administration of anti-hepatitis B surface antigen (anti-HBs) immune globulin is beneficial. Methods: We conducted a retrospective study at 17 European centers of 372 consecutive HBsAg-positive patients who underwent liver transplantation between 1977 and 1990. Recurrence of HBV infection was defined as the reappearance of HBsAg in serum. Results: For all 334 patients with follow-up data, the mean (±SE) three-year actuarial risk of recurrence of HBV was 50 ±3 percent. The risk was 67 ±4 percent among 163 patients with HBV-related cirrhosis, 32 ±5 percent among 110 patients with cirrhosis related to hepatitis delta virus, 40 ±16 percent among 14 patients with fulminant hepatitis delta infection, and 17 ±7 percent among 39 patients with fulminant HBV infection (P<0.001). Among the patients with HBV-related cirrhosis, the risk of HBV recurrence was greatest (83 ±6 percent) in those who were seropositive for HBV DNA at the time of transplantation and lowest (58 ±7 percent) in those with neither HBV DNA nor hepatitis B e antigen detectable in serum. With respect to the use of passive prophylaxis with anti-HBs immune globulin, the risk of HBV recurrence was 75 ±6 percent among the 67 patients given no immunoprophylaxis, 74 ±5 percent among the 83 treated for two months, and 36 ±4 percent among the 209 treated for six months or longer (P<0.001). In a multivariate analysis the predictors of a lower risk of HBV recurrence were the long-term administration of the immune globulin, hepatitis delta virus superinfection, and acute liver disease. For the entire study cohort, survival was 75 percent at one year and 63 percent at three years, but for those in whom HBV infection recurred, survival was 68 percent at one year and 44 percent at three years. Conclusions: In this retrospective study of HBsAg-positive patients, liver transplantation had better results in those who had fulminant hepatitis or delta virus superinfection. An absence of viral replication at the time of transplantation and long-term immunoprophylaxis were associated with a reduced risk of recurrent HBV infection and reduced mortality.Massachusetts Medical Society1993info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/122709Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1056/NEJM199312163292503New England Journal of Medicine, 1993, vol. 329, p. 1842-1847https://doi.org/10.1056/NEJM199312163292503(c) Massachusetts Medical Society, 1993info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1227092026-05-27T06:46:51Z
dc.title.none.fl_str_mv Liver transplantation in European patients with the hepatitis B surface antigen
title Liver transplantation in European patients with the hepatitis B surface antigen
spellingShingle Liver transplantation in European patients with the hepatitis B surface antigen
Samuel, Didier
Trasplantament hepàtic
Hepatitis B
Virus de l'hepatitis B
Europa
Estudi de casos
Hepatic transplantation
Hepatitis B
Hepatitis B virus
Europe
Case studies
title_short Liver transplantation in European patients with the hepatitis B surface antigen
title_full Liver transplantation in European patients with the hepatitis B surface antigen
title_fullStr Liver transplantation in European patients with the hepatitis B surface antigen
title_full_unstemmed Liver transplantation in European patients with the hepatitis B surface antigen
title_sort Liver transplantation in European patients with the hepatitis B surface antigen
dc.creator.none.fl_str_mv Samuel, Didier
Muller, Rainer
Alexander, Graeme
Fassati, Luigi
Ducot, Beatrice
Benhamou, Jean-Pierre
Bismuth, Henri
Jaurrieta Mas, Eduardo
European Concerted Action on Viral Hepatitis Study
author Samuel, Didier
author_facet Samuel, Didier
Muller, Rainer
Alexander, Graeme
Fassati, Luigi
Ducot, Beatrice
Benhamou, Jean-Pierre
Bismuth, Henri
Jaurrieta Mas, Eduardo
European Concerted Action on Viral Hepatitis Study
author_role author
author2 Muller, Rainer
Alexander, Graeme
Fassati, Luigi
Ducot, Beatrice
Benhamou, Jean-Pierre
Bismuth, Henri
Jaurrieta Mas, Eduardo
European Concerted Action on Viral Hepatitis Study
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Trasplantament hepàtic
Hepatitis B
Virus de l'hepatitis B
Europa
Estudi de casos
Hepatic transplantation
Hepatitis B
Hepatitis B virus
Europe
Case studies
topic Trasplantament hepàtic
Hepatitis B
Virus de l'hepatitis B
Europa
Estudi de casos
Hepatic transplantation
Hepatitis B
Hepatitis B virus
Europe
Case studies
description Background: The role of liver transplantation in patients positive for the hepatitis B surface antigen (HBsAg) is controversial because of the high rate of recurrent hepatitis B virus (HBV) infection. It has not been determined whether this risk is greater for certain patients and whether the administration of anti-hepatitis B surface antigen (anti-HBs) immune globulin is beneficial. Methods: We conducted a retrospective study at 17 European centers of 372 consecutive HBsAg-positive patients who underwent liver transplantation between 1977 and 1990. Recurrence of HBV infection was defined as the reappearance of HBsAg in serum. Results: For all 334 patients with follow-up data, the mean (±SE) three-year actuarial risk of recurrence of HBV was 50 ±3 percent. The risk was 67 ±4 percent among 163 patients with HBV-related cirrhosis, 32 ±5 percent among 110 patients with cirrhosis related to hepatitis delta virus, 40 ±16 percent among 14 patients with fulminant hepatitis delta infection, and 17 ±7 percent among 39 patients with fulminant HBV infection (P<0.001). Among the patients with HBV-related cirrhosis, the risk of HBV recurrence was greatest (83 ±6 percent) in those who were seropositive for HBV DNA at the time of transplantation and lowest (58 ±7 percent) in those with neither HBV DNA nor hepatitis B e antigen detectable in serum. With respect to the use of passive prophylaxis with anti-HBs immune globulin, the risk of HBV recurrence was 75 ±6 percent among the 67 patients given no immunoprophylaxis, 74 ±5 percent among the 83 treated for two months, and 36 ±4 percent among the 209 treated for six months or longer (P<0.001). In a multivariate analysis the predictors of a lower risk of HBV recurrence were the long-term administration of the immune globulin, hepatitis delta virus superinfection, and acute liver disease. For the entire study cohort, survival was 75 percent at one year and 63 percent at three years, but for those in whom HBV infection recurred, survival was 68 percent at one year and 44 percent at three years. Conclusions: In this retrospective study of HBsAg-positive patients, liver transplantation had better results in those who had fulminant hepatitis or delta virus superinfection. An absence of viral replication at the time of transplantation and long-term immunoprophylaxis were associated with a reduced risk of recurrent HBV infection and reduced mortality.
publishDate 1993
dc.date.none.fl_str_mv 1993
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/122709
url https://hdl.handle.net/2445/122709
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1056/NEJM199312163292503
New England Journal of Medicine, 1993, vol. 329, p. 1842-1847
https://doi.org/10.1056/NEJM199312163292503
dc.rights.none.fl_str_mv (c) Massachusetts Medical Society, 1993
info:eu-repo/semantics/openAccess
rights_invalid_str_mv (c) Massachusetts Medical Society, 1993
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Massachusetts Medical Society
publisher.none.fl_str_mv Massachusetts Medical Society
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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