Over the last 15 years there have been several important innovations in the care of patients undergoing liver transplantation for viral hepatitis B.
In this study, doctors from Rochester, Minnesota, analyzed the survival of liver recipients with HBV in the United States to examine the effect of these innovations.
The team conducted a retrospective analysis based on data from the United Network for Organ Sharing. They assessed all patients over 18 years who underwent primary liver transplantation between 1987 and 2002.
The team identified recipients with HBV using a principal diagnosis of acute or chronic HBV or positive results on HBV markers.
The patients were divided into 3 groups:
- Era 1 (1987-1991) = 6708 patients (675 with HBV)
- Era 2 (1992-1996) = 13,995 patients (1005 with HBV)
- Era 3 (1997-2002) = 20,730 (1723 with HBV).
Overall, the doctors found that more recent patients were older, had less advanced liver disease, and a shorter ischemic time.
The team determined that the survival of patients with HBV was significantly better for era 2 than for era 1, and for era 3 than for era 2.
|There was no effect of fulminant disease on patient survival.|
They were unable to detect any difference in survival between patients with HBV and all other diagnoses for era 3.
Era remained significant when recipient and donor age, warm ischemic time, pre-transplantation disease severity, and hepatocellular carcinoma were taken into account.
The team did not find any effect of fulminant disease and Asian race on patient survival.
Dr Ray Kim and colleagues concluded, "These data underscore the effectiveness of therapeutic innovations that have occurred in the past 2 decades and indicate timely and widespread adoption of these measures by transplant centers nationwide".