Indications for liver transplantation in patients with chronic hepatitis Band C virus infection and hepatocellular carcinoma

Patients with chronic hepatitis B virus (HBV) infection were not accepted f or liver transplantation in Asia in the past because the hepatitis B immune globulin (HBIG) used to prevent posttransplantation recurrence was very ex pensive and it was generally believed that Asians with hepatitis B fared wo rse than Caucasians after liver transplantation. The availability of lamivu dine has altered the indication of liver transplantation for these patients . Twenty-five Chinese patients with chronic HBV infection were given lamivu dine as primary prophylaxis against HBV re-infection before transplantation . Five patients died within 40 days of transplantation. After a median foll ow-up period of 14 months (range, 5-39), 17 patients had lost serum HBsAg f rom 4 days to 27 months post transplantation, but it reappeared in three pa tients 4-12 months later. Antibody to HBsAg was detected periodically in th e serum of 11 patients who had lost HBsAg. At the last follow-up, six patie nts were HBsAg-positive and HBV DNA was detected in only one of them. The i ndication fur liver transplantation for chronic hepatitis C virus (HCV) inf ection is not as strict as for patients with chronic HBV infection because the longterm survival is similar to that of non-hepatitis C patients, even though re-infection by HCV in the recipients is nearly universal. The main issue in the selection of patients with HCV for liver transplantation is th erefore identification of criteria that can predict re-infection and develo pment of cirrhosis. These include factors such as multiple episodes of reje ction, use of OKT3, pre-transplant viral load and genotype, but reports are not consistent and so there are no well-defined selection criteria. The se lection criteria for patients with hepatocellular carcinoma are now well de fined, Many studies have confirmed that a tumour > 5 cm, and showing vascul ar invasion, and poor differentiation adversely affects survival. In practi ce, only patients with a tumour < 5 cm and Child's C cirrhosis are accepted for liver transplantation. Transarterial oily chemoembolization and intral esional alcohol injection are used to control or down-stage the tumour whil e patients wait for a cadaveric liver graft. (C) 2000 Blackwell Science Asi a Pty Ltd.