Since the early 1990s, therapeutic options for patients undergoing liver transplantation for hepatitis B have evolved to include HBV immune globulin (HBIG) and lamivudine.
At the same time, the outcomes for liver transplant recipients with hepatitis B improved dramatically, as detailed in a new study published in the August 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS).
Liver Transplantation is published on behalf of the societies by John Wiley & Sons, Inc., and is available online via Wiley InterScience.
Before the arrival of HBIG and lamivudine, people with hepatitis B were poor candidates for liver transplantation, because the virus almost always infected and destroyed their new organ. Then therapeutic innovations arrived. In the early 1990s in the United States, HBIG became widely used after being shown to significantly reduce the incidence of recurrent hepatitis B. In 1995, lamivudine was found to be effective against hepatitis B. Most recently, new antiviral agents like adefovir may help patients whose hepatitis B is resistant to other therapies.
In light of these innovations, researchers, led by W. Ray Kim, M.D., of the Mayo Clinic, examined 15 years of data on outcomes after liver transplantation for recipients with hepatitis B-related liver disease. The researchers hypothesized that these patients' survival would have improved over time, more than that of transplant recipients with other diagnoses, likely due to the therapeutic advances.
The researchers used data from the United Network for Organ Sharing (UNOS) for all adults receiving transplants between 1987 and 2002. They divided the data into three time frames: Era 1(1987-1991) when no prophylaxis was routinely used; Era 2 (1992-1996) when HBIG was used alone; and Era 3 (1997- 2002) when both HBIG and lamivudine were used together. They collected information on each patient's diagnosis and survival after transplant and used statistical analyses to compare survival between groups. They also analyzed demographic and other data such as age, race and ischemic times.
As the eras progressed, the 5-year-survival for patients with hepatitis B improved impressively, from 53 percent to 69 percent to 76 percent. At the same time, liver transplant recipients with hepatitis B went from having significantly lower survival rates than those with other diagnoses, to having comparable, if not higher, survival rates.
"These continual improvements suggest that advances in the prevention and treatment of recurrent HBV disease have been adopted in a timely and widespread fashion," report the authors.
Due to a lack of available data on post-transplant patient management, histology, and prophylactic regimen, the researchers were not able to directly correlate the outcome improvements with therapeutic innovations. Still, they report that the outcome of liver transplantation for patients with hepatitis B has improved significantly over the past 17 years, commensurate with therapeutic innovations introduced during the same period.
"These data underscore the importance of therapeutic innovations that have occurred incrementally in the past two decades for hepatitis B and support liver transplantation as an appropriate treatment for patients with acute and chronic insufficiency or HCC from HBV," the authors conclude.