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Liver transplantation in Asian patients with chronic hepatitis B
Author(s) -
Ho B. M.,
So S. K.,
Esquivel C. O.,
Keeffe E. B.
Publication year - 1997
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510250140
Subject(s) - medicine , hepatitis b immune globulin , transplantation , liver transplantation , hepatitis b virus , hepatitis b , hepatitis , gastroenterology , surgery , immunology , hbsag , virus
It has been suggested that Asian patients have reduced survival after liver transplantation because of greater recurrence of hepatitis B virus (HBV). We analyzed the outcome of Asian and non‐Asian patients receiving transplants for chronic hepatitis B between May 1988 and March 1994. Baseline Child‐Pugh score and United Network for Organ Sharing (UNOS) status, HBV recurrence, and survival were compared between the two groups. All but one patient received variable doses of hepatitis B immune globulin. Mean follow‐up of surviving patients was 28 months (range, 3‐71 months). Fifteen Asians and 20 non‐Asians underwent transplantation. Six of 15 Asians (40%) and 4 of 20 non‐Asians (20%) died during the study period. Although Asians had a lower 1‐year survival than non‐Asians (59% for Asians and 94% for non‐Asians), the 5‐year actuarial survival was not different (59% and 57% for Asians and non‐Asians, respectively). The causes of death in 5 of 6 Asians were factors other than recurrent hepatitis B, and 4 of 5 deaths occurred within 60 days after transplantation. Eighty percent of Asian patients were Child‐Pugh class C at referral, compared with 50% of non‐Asians, and Asians were more likely to be status 1 at transplantation (40% vs. 10%; P < .05). By contrast, all four deaths in non‐Asians occurred late and were secondary to recurrent HBV infection. Of patients surviving more than 60 days after transplantation, 7 of 11 Asians (64%) and 10 of 20 non‐Asians (50%) developed recurrent HBV infection (NS). Late mortality attributable to HBV recurrence was lower but not significantly different in Asians (1 of 7 [14%]) than in non‐Asians (4 of 10 [40%]). In summary, HBV recurrence and late HBV‐related mortality in Asians and non‐Asians is similar after liver transplantation for chronic hepatitis B. Late referral and more advanced chronic liver disease at the time of transplantation probably account for the lower 1‐year survival of Asians after liver transplantation.