| Contributors: |
Burra, P; Battistella, S; Turco, L; Morelli, M; Frassanito, G; De Maria, N; Pasulo, L; Fagiuoli, S; Di Benedetto, C; Donato, M; Magro, B; Pagano, D; Bhoori, S; Mazzaferro, V; Lauterio, A; De Carlis, L; Forastiere, D; Rendina, M; Angrisani, D; Lanza, A; Scandali, G; Svegliati Baroni, G; Piano, S; Angeli, P; Manuli, C; Martini, S; De Simone, P; Vacca, P; Ghinolfi, D; Lionetti, R; Giannelli, V; Mameli, L; Fornasiere, E; Toniutto, P; Biolato, M; Ponziani, F; Lenci, I; Ferrarese, A; Passigato, N; Marenco, S; Giannini, E; Ferri, F; Trapani, S; Grossi, P; Aghemo, A; Zanetto, A; Russo, F |
| Description: |
Background & Aims: Conflicting data exist regarding optimal prophylaxis for HBV recurrence (HBV-R) after liver transplantation (LT), particularly in patients with hepatocellular carcinoma (HCC). We assessed current practices for HBV-R prophylaxis in Italy, evaluating rates, risk factors, and the clinical impact of HBV-R and HCC-R. Methods: We performed a multicentric, retrospective study involving 20 Italian LT centers. All patients who underwent LT for HBV-related liver diseases between 2010 and 2021 were included. Logistic regression was used to identify predictors of HBV-R and HCC-R. Survival curves were estimated with the Kaplan-Meier method and compared with the log-rank test. Results: We included 1,205 LT recipients (60.8% with HCC). HBV prophylaxis was prescribed in 99.7% of recipients, mostly with lifelong hepatitis B immunoglobulin+nucleos(t)ide analogues (HBIG+NUCs) (83.9%). Rates of HBV-R were 2.1% and 3.1% in patients transplanted without and with HCC, respectively. Median times from LT were 60 [9.5–77.5] and 5.5 [1–13] months, respectively. Recipients on lifelong HBIG+NUCs experienced lower rates of HBV-R than those in whom HBIG was withdrawn, used only during LT, or in those who received NUCs alone (2.3% vs. 6.2% vs. 1.9% vs. 8%, respectively; p = 0.042). In recipients with HCC, HCC-R rate was 10.8% (median time from LT: 18 months). At multivariate analysis, HBV-R (odds ratio [OR] 10.329; 95% CI 3.665-29.110), Child-Pugh C (OR 3.519; 95% CI 1.305-9.484), and microvascular invasion (OR 3.088; 95% CI 1.692-5.634) were independently associated with HCC-R. Five-year survival was lower in recipients who experienced HCC-R (32.5% vs. 92.4% in those who did not; p |