LONG-TERM CLINICAL AND VIROLOGICAL OUTCOME AFTER LIVER-TRANSPLANTATION FOR CIRRHOSIS CAUSED BY CHRONIC DELTA-HEPATITIS

Liver transplantation for liver diseases related to hepatitis B virus (HBV) and hepatitis delta virus (HDV) remains problematic. because of the risk of Viral recurrence, We report here the long-term virological outcome of patients transplanted for HDV-related liver cirrhosis (HDV cirrhosis). From December 1984 to December 1990, 76 patients with KDV cirrhosis underwent liver transplantation, Before transplantation, al l the patients were HBsAg-positive/anti-HDV positive, and all but one were HBV DNA-negative by dot blot hybridization. HDV RNA was detected by HDV RT-PCR and liver HDAg by fluorescent HDV Ab, After transplantat ion, all the patients except four received continuous long-term anti-H Bs passive immunoprophylaxis. The actuarial 5-year survival was 88%. A ll patients who did not receive anti-HBs immunoprophylaxis remained HB sAg-positive and developed hepatitis, Among the 68 patients receiving anti-HBs immunoprophylaxis with a minimum follow-up of 2 months, HBsAg reappeared in 7 (10.3%) after a mean of 17 months, These seven patien ts developed hepatitis, with simultaneous HBV and HDV replication; and four cleared later HBsAg, Patients without HBV reinfection were studi ed for HDV reinfection: liver HD Ag or serum HDV RNA were present in 8 8% of the patients during the first year, without developing hepatitis ; however, they were no longer detectable after 2 years in 95% of the patients. In conclusion, liver transplantation for HDV cirrhosis gives good results, with a 5-year actuarial survival of 88%. Reappearance o f HBsAg occurred in 13.2% and was associated with HBV and HDV reactiva tion and hepatitis, Among patients who remained HBsAg negative, HDV ma rkers were detectable during the first year, without the development o f hepatitis, but disappeared in the long term in most cases.