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...

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Veröffentlicht in:American journal of transplantation Jg. 25; H. 7; S. 1502 - 1514
Hauptverfasser: 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
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.07.2025
Schlagworte:
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
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Zusammenfassung: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.
Bibliographie: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