Liver transplantation for hepatitis D virus/hepatitis B virus coinfection in Italy: An intention-to-treat analysis of long-term outcomes

Patients with hepatitis D virus (HDV)/hepatitis B virus (HBV)-related end-stage liver disease candidates for liver transplantation (LT) have traditionally been regarded as a special population, although their outcomes are controversial. An intention-to-treat (ITT) analysis of long-term outcomes of H...

Full description

Saved in:

Bibliographic Details
Published in:	American journal of transplantation Vol. 25; no. 7; pp. 1502 - 1514
Main Authors:	Angelico, Roberta, Trapani, Silvia, Manzia, Tommaso Maria, Lenci, Ilaria, Grossi, Paolo, Ricci, Andrea, Burra, Patrizia, Andorno, Enzo, Agnes, Salvatore, Bhoori, Sherrie, Baccarani, Umberto, Belli, Luca S., Carrai, Paola, Caccamo, Lucio, Carraro, Amedeo, Cescon, Matteo, Colledan, Michele, Cillo, Umberto, De Carlis, Luciano, De Maria, Nicola, De Simone, Paolo, di Benedetto, Fabrizio, Donato, Maria Francesca, Maria Ettorre, Giuseppe, Ferri, Flaminia, Lanza, Alfonso Galeota, Ghinolfi, Davide, Grieco, Antonio, Gruttadauria, Salvatore, Marenco, Simona, Martini, Silvia, Mazzaferro, Vincenzo, Pellicelli, Adriano, Pinelli, Domenico, Rendina, Maria, Rizzetto, Mario, Romagnoli, Renato, Rossi, Massimo, Russo, Francesco Paolo, Schiadà, Laura, Tandoi, Francesco, Toniutto, Pierluigi, Turco, Laura, Vennarecci, Giovanni, Viganò, Mauro, Vivarelli, Marco, Tisone, Giuseppe, Feltrin, Giuseppe, Nardi, Alessandra, Angelico, Mario
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.07.2025
Subjects:	Adult Aged Carcinoma, Hepatocellular - surgery Carcinoma, Hepatocellular - virology chirrosis Coinfection - mortality Coinfection - surgery Coinfection - virology End Stage Liver Disease - mortality End Stage Liver Disease - surgery End Stage Liver Disease - virology Female Follow-Up Studies Graft Survival Hepatitis B - complications Hepatitis B - surgery Hepatitis B - virology hepatitis B infection Hepatitis B virus - isolation & purification Hepatitis D - complications Hepatitis D - mortality Hepatitis D - surgery Hepatitis D - virology hepatitis D infection Hepatitis Delta Virus - isolation & purification hepatocellularcarcinoma Humans Italy - epidemiology Liver Neoplasms - surgery liver transplantation Liver Transplantation - mortality Male Middle Aged outcomes Prognosis Retrospective Studies Risk Factors Survival Rate viral prophylaxis Waiting Lists - mortality Italy CNT ITT LT HBsAg HCC IQR viral prophylaxis chirrosis NA MELD hepatitis B infection outcomes WL hepatocellularcarcinoma HBIg HDV hepatitis D infection HBV liver transplantation
ISSN:	1600-6135, 1600-6143, 1600-6143
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Patients with hepatitis D virus (HDV)/hepatitis B virus (HBV)-related end-stage liver disease candidates for liver transplantation (LT) have traditionally been regarded as a special population, although their outcomes are controversial. An intention-to-treat (ITT) analysis of long-term outcomes of HDV/HBV-coinfected patients waitlisted for LT in Italy, between 2011 and 2020, was performed and compared with HBV-monoinfected LT candidates. Of 1731 HBV-infected LT candidates, 1237 (71.5%) had HBV monoinfection and 494 (28.5%) HDV/HBV coinfection. At listing, HDV/HBV-coinfected patients were significantly younger, listed mainly for decompensated cirrhosis, and with fewer hepatocellular carcinoma (HCC) cases; (26% vs 65.8%; P <.0001) compared with HBV-monoinfected patients. HDV/HBV-coinfected patients showed better 5-year ITT survival (83.2%; 95% CI: 79.4%-83.4%, vs 71.6%; 95% CI: 68.8%-74.2%; P < .0001). ITT-multivariable analysis identified the presence of HCC, advanced recipient age, and high model for end-stage liver disease-Na scores as mortality risk factors. Five years after LT, 99.1% of HDV/HBV-coinfected patients received oral nucleos(t)ide analogs, with immunoglobulins against antigen of the hepatitis B virus in 91.8% of cases. HBV and HDV viral recurrences were 1.1% and 0.2%, respectively, whereas recurrent or de novo HCC were 8.9% and 0.3%, respectively. In Italy, HDV/HBV-coinfected patients waitlisted for LT showed more favorable outcomes compared with HBV-monoinfected patients, both before and after LT. These excellent results, from the largest cohort reported so far, suggest that HDV/HBV-coinfected LT recipients do not represent a risky population and may be considered for simpler long-term antiviral prophylactic strategies.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1600-6135 1600-6143 1600-6143
DOI:	10.1016/j.ajt.2025.03.003