*Purpose: Combination of anti-hepatitis B immunoglobulin and antiviral agents is the standard care for prophylaxis of hepatitis B virus (HBV) recurrence after liver transplantation. However, around 10% of the patients still have HBV recurrence. The clinical courses after HBV recurrence is less mentioned. This study aims to investigate the clinical presentation after HBV recurrence

*Methods: 313 HBV patients had liver transplantation at Chang-Gung Memorial Hospital from 2005 to 2015. Forty-eight patients having HBV recurrence were included in this study. The patients were divided into group A, the patients with HBV only; and group B, the patients with HBV and hepatocellular carcinoma (HCC). The clinical presentations after HBV recurrence were recorded.

*Results: Among 48 patients with HBV recurrence, 23 patients (19 males and 4 females) were in group A and 25 patients (22 males and 3 females) in group B. The age were 51.6±9.4 years in group A and 52.8±6.4 in group B (p = 0.869). The MELD score before transplantation was 23.1±9.9 in group A patients and 12.9±5.6 in group B patients (p < 0.001). The median (interquartile) interval from transplantation to HBV recurrence was 10 (2-19) months for group A patients and 13 (8.5-35) months for group B patients (p = 0.051). In group B patients, 10 (40%) patients had HCC recurrence. Seven of the 10 patients had HCC recurrence after HBV recurrence. The median (interquartile) interval from transplantation to HBV recurrence was 11 (7.5-29.8) months for the patients with HCC recurrence, compare to 15 (11-40) months for the patients without HCC recurrence (p=0.453). After HBV recurrence, the liver function was almost normal in both groups. However, 8 patients in group A died of biliary infection (n=4), pneumonia (n=2), portal vein stenosis (n=1) and alcoholic hepatitis (n=1). Eleven patients in group B died of HCC recurrence (n=10) and coronary heart disease (n=1). The 1-, 3- and 5-year survival rates were 82.6%, 73.9% and 69.0%, respectively, for group A patients and 96%, 76% and 68%, respectively, in group B patients (p = 0.713).

*Conclusions: After HBV recurrence, the patients still have uneventful liver function under antiviral agent control. However, for the patients having HCC, most of the HCC recurs after HBV recurs. Close monitoring of HCC recurrence is paramount if HBV recurs.

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