Association Between Hepatitis B and Hepatocellular Carcinoma Recurrence in Patients Undergoing Liver Transplantation

Abstract

Background/Aims Hepatitis B virus (HBV) and hepatocellular carcinoma (HCC) recurrences affect both patient and graft survivals post–orthotopic liver transplantation (OLT) in HBV patients with HCC. We analyzed the relationship between HBV and HCC recurrence in a large cohort of HBV-OLT patients with versus without HCC. Methods Two hundred eighty-seven HBV patients with OLT (72 also with HCC) were included in the study. Mean follow-up in the post-OLT period was 31.7 ± 24.7 (range, 3–119) months. Results Post-OLT HBV recurrence observed in 10.1% of patients was more prevalent among the HCC group; 23.6% versus 5.5% in patients with and without HCC, respectively. The mean interval for the development of HBV recurrence was 39.5 ± 28.5 (range, 2–99) months. Among 72 HCC patients, 8 patients (11.1%) had recurrent HCC, and 7 of them also had HBV recurrence. The mean interval for the development of HCC recurrence was 11.2 ± 7.85 (range, 2–23) months after OLT. OLT patients with HCC with tumors exceeding the Milan criteria had worse 1-, 3-, and 5-year survival rates than patients with HCC meeting the Milan criteria. HBV and HCC recurrence-free survivals were significantly lower in patients with HCC and HBV recurrence, respectively. In the 7 patients with both HCC and HBV recurrence, mean HBV recurrence time was 9.42 ± 6.75 months and mean HCC recurrence time was 9.57 ± 6.75 months. There was a strong correlation between HBV and HCC recurrence times. Cox proportional hazards regression analysis showed that only HCC recurrence was a significant independent predictor of HBV recurrence ( P < .001; hazard ratio [HR] = 26.94; 95% confidence interval [CI] = 10.81–67.11). On the other hand, HBV recurrence ( P = .013; HR = 5.80; 95% CI = 1.45–23.17) and nodule count ( P = .014; HR = 13.08; 95% CI = 1.70–100.83) were significant predictors of HCC recurrence. Conclusions HBV and HCC recurrences demonstrate a close relationship in patients with OLT.