SURVIVAL AFTER LIVER-TRANSPLANTATION FOR CHRONIC HEPATITIS-B USING REDUCED IMMUNOSUPPRESSION

Background/Aims: Recurrent hepatitis B virus infection after liver tra nsplantation performed for chronic hepatitis B with cirrhosis is influ enced by a number of factors, including coinfection with the hepatitis D virus, the level of HBV replication, and administration of hepatiti s B immune globulin, Another potentially important factor in modulatin g HBV infection after liver transplantation is the degree of immunosup pression post-transplant. We reviewed an institutional experience with liver transplantation for chronic hepatitis B and analyzed the impact of using lower doses of corticosteroids on HBV reinfection, expressio n of recurrent HBV disease and patient survival. Methods: Of 17 patien ts undergoing liver transplantation for chronic hepatitis B, 16 patien ts received variable doses of hepatitis B immune globulin for up to 6 months. Results: Fifteen of the 16 patients remained HBsAg-negative du ring hepatitis B immune globulin therapy, but ultimately 13 of the 17 patients had HBV reinfection, including 3 of 4 patients with hepatitis D virus coinfection, Long-term survival (82%) of the 17 chronic hepat itis B patients was not different from the survival (75%) of 195 patie nts transplanted for other indications, Three of 13 patients who were reinfected died from chronic hepatitis B with liver failure. Reinfecti on did not appear to be related to the pretransplant degree of viral r eplication. Compared to an age- and sex-matched control group, patient s undergoing liver transplantation for chronic hepatitis B received le ss cumulative intravenous methylprednisolone and oral prednisone, but did not experience a higher rate of graft rejection. Conclusions: We p ostulate that use of lower doses of corticosteroids after liver transp lantation for chronic hepatitis B is safe and not associated with a hi gher incidence of graft rejection. Moreover, low-dose maintenance pred nisone therapy may modify the:course of post-transplant HBV reinfectio n by leading to less viral replication, milder HBV-related liver disea se and better patient survival.