Background/aim: Hepatitis B virus (HBV) and hepatitis delta virus (HDV) coinfection often leads to severe chronic hepatitis and cirrhosis. Data on long term outcome of liver transplantation (LT) for coinfected patients is limited. The aim of this study was to assess the prevalence of HBV and HDV coinfection in our transplant population and to evaluate its long term impact on LT.

Methods: Between January 1990 and December 2011 a total of 133(106 males and 27 females) patients were transplanted at our center for HBV related cirrhosis. 32(24%) patients were coinfected with HDV while 70 patients tested negative for HDV. The HDV status was not available for 31 patients. All patients received post transplant combination therapy with nucleos(t)ide analogue and anti-hepatitis B immunoglobulins. Breakthrough infection was defined as re-emergence of HBV-DNA or HBsAg while on treatment.

Results: Patients were followed for an average of 82 months (range 1-274). Post LT survival and HBV recurrence during the follow up period were 89% and 11 %, respectively. All 15 patients developed breakthrough infection while on monotherapy and were controlled with switching or adding another oral agent. Factors associated with disease recurrence included: younger age(44vs51.4 years, p=0.0162), positive pretransplant HBeAg (60%vs14%, p<0.005), detectable pretransplant HBV-DNA (80%vs37%, p=0.008), and positive post transplant HbsAg (80%vs4%, p<0.005).

Patients with HBV and HDV coinfection were similar to HBV monoinfected patients in terms of age at time of transplantation (47vs51 years, p=0.14), pretransplant model for end stage liver disease (MELD) score (22vs20, p= 0.2), and disease recurrence post LT (6%vs11%, p=0.41). Delta infection was not a significant predictor of death as none of the patients who had HDV died.

Conclusion: Despite the aggressive course of HBV and HDV coinfection in immunocompetent patients, LT outcome is similar to HBV monoinfection.

« Back to 2013 American Transplant Congress