Background and aims Conflicting data exist regarding optimal prophylaxis for HBV recurrence (HBV-R) after liver transplantation (LT), particularly in patients with hepatocellular carcinoma (HCC). We assessed current practices for HBV-R prophylaxis in Italy, evaluating rates, risk factors, and clinical impact of HBV-R and HCC-R. Methods Multicentric, retrospective study involving 20 Italian LT centers. All patients who underwent LT for HBV-related liver diseases between 2010 and 2021 were included. Logistic regression was used to identify predictors of HBV-R and HCC-R. Survival curves were estimated with Kaplan-Meier method and compared with log-rank test. Results We included 1205 LT recipients (60.8% HCC). HBV prophylaxis was prescribed in 99.7% recipients, mostly with lifelong HBIG+NUCs (83.9%). Rates of HBV-R were 2.1% and 3.1% in patients transplanted without and with HCC, respectively. Median times from LT were 60 [9.5–77.5] and 5.5 [1–13] months, respectively. Recipients on lifelong HBIG+NUCs experienced lower rates of HBV-R than those in whom HBIG were withdrawn, used only during LT, or received NUCs alone (2.3% vs. 6.2% vs. 1.9% vs. 8%, respectively; p=0.042). In HCC recipients, HCC-R rate was 10.8% (median time from LT: 18 months). At multivariate analysis, HBV-R (OR: 10.329; 95%CI: 3.665-29.110), Child-Pugh C (OR: 3.519; 95%CI: 1.305-9.484), and microvascular invasion (OR: 3.088; 95%CI: 1.692-5.634) were independently associated with HCC-R. Five-year survival was lower in recipients who experienced HCC-R (32.5% vs. 92.4% in those who did not; p<0.001). Conclusion In Italy, HBV prophylaxis is mostly based on lifelong HBIG+NUCs. HBV-R was rare and not associated with survival in patients transplanted for decompensated cirrhosis. In patients transplanted for HCC, HBV-R was independently associated with HCC-R. The clinical implications of these findings deserve further investigation.

Liver transplantation for HBV-related liver disease: impact of prophylaxis for HBV on HCC recurrence / Burra, Patrizia; Battistella, Sara; Turco, Laura; Morelli, Maria Cristina; Frassanito, Gabriella; De Maria, Nicola; Pasulo, Luisa; Fagiuoli, Stefano; Di Benedetto, Clara; Donato, Maria Francesca; Magro, Bianca; Pagano, Duilio; Bhoori, Sherrie; Mazzaferro, Vincenzo; Lauterio, Andrea; De Carlis, Luciano; Forastiere, Domenico; Rendina, Maria; Angrisani, Debora; Lanza, Alfonso Galeota; Scandali, Giulia; Baroni, Gianluca Svegliati; Piano, Salvatore; Angeli, Paolo; Manuli, Chiara; Martini, Silvia; De Simone, Paolo; Vacca, Pier Giuseppe; Ghinolfi, Davide; Lionetti, Raffaella; Giannelli, Valerio; Mameli, Laura; Fornasiere, Ezio; Toniutto, Pierluigi; Biolato, Marco; Ponziani, Francesca Romana; Lenci, Ilaria; Ferrarese, Alberto; Passigato, Nicola; Marenco, Simona; Giannini, Edoardo; Ferri, Flaminia; Trapani, Silvia; Grossi, Paolo; Aghemo, Alessio; Zanetto, Alberto; Russo, Francesco Paolo; Vivian, Laura Marta; Schiavone, Silvia; Colledan, Michele; Loglio, Alessandro; Viganò, Raffaella; Belli, Luca Saverio; Castellaneta, Antonino; Calleri, Alberto; Carrai, Paola; Adorno, Enzo; Agnes, Salvatore; Baccarani, Umberto; Caccamo, Lucio; Carraro, Amedeo; Cescon, Matteo; Cillo, Umberto; Di Benedetto, Fabrizio; Ettorre, Giuseppe Maria; Grattadauria, Salvatore; Pinelli, Domenico; Romagnoli, Renato; Rossi, Massimo; Tandoi, Francesco; Tisone, Giuseppe; Vennarecci, Giovanni; Vivarelli, Marco; Zamboni, Fausto. - In: JHEP REPORTS. - ISSN 2589-5559. - (2025). [10.1016/j.jhepr.2024.101278]

Liver transplantation for HBV-related liver disease: impact of prophylaxis for HBV on HCC recurrence

Turco, Laura;Scandali, Giulia;Giannelli, Valerio;Giannini, Edoardo;Ferri, Flaminia;Grossi, Paolo;Rossi, Massimo;Vivarelli, Marco;
2025

Abstract

Background and aims Conflicting data exist regarding optimal prophylaxis for HBV recurrence (HBV-R) after liver transplantation (LT), particularly in patients with hepatocellular carcinoma (HCC). We assessed current practices for HBV-R prophylaxis in Italy, evaluating rates, risk factors, and clinical impact of HBV-R and HCC-R. Methods Multicentric, retrospective study involving 20 Italian LT centers. All patients who underwent LT for HBV-related liver diseases between 2010 and 2021 were included. Logistic regression was used to identify predictors of HBV-R and HCC-R. Survival curves were estimated with Kaplan-Meier method and compared with log-rank test. Results We included 1205 LT recipients (60.8% HCC). HBV prophylaxis was prescribed in 99.7% recipients, mostly with lifelong HBIG+NUCs (83.9%). Rates of HBV-R were 2.1% and 3.1% in patients transplanted without and with HCC, respectively. Median times from LT were 60 [9.5–77.5] and 5.5 [1–13] months, respectively. Recipients on lifelong HBIG+NUCs experienced lower rates of HBV-R than those in whom HBIG were withdrawn, used only during LT, or received NUCs alone (2.3% vs. 6.2% vs. 1.9% vs. 8%, respectively; p=0.042). In HCC recipients, HCC-R rate was 10.8% (median time from LT: 18 months). At multivariate analysis, HBV-R (OR: 10.329; 95%CI: 3.665-29.110), Child-Pugh C (OR: 3.519; 95%CI: 1.305-9.484), and microvascular invasion (OR: 3.088; 95%CI: 1.692-5.634) were independently associated with HCC-R. Five-year survival was lower in recipients who experienced HCC-R (32.5% vs. 92.4% in those who did not; p<0.001). Conclusion In Italy, HBV prophylaxis is mostly based on lifelong HBIG+NUCs. HBV-R was rare and not associated with survival in patients transplanted for decompensated cirrhosis. In patients transplanted for HCC, HBV-R was independently associated with HCC-R. The clinical implications of these findings deserve further investigation.
2025
HBV HCC HDV liver transplantation HBV recurrence HCC recurrence
01 Pubblicazione su rivista::01a Articolo in rivista
Liver transplantation for HBV-related liver disease: impact of prophylaxis for HBV on HCC recurrence / Burra, Patrizia; Battistella, Sara; Turco, Laura; Morelli, Maria Cristina; Frassanito, Gabriella; De Maria, Nicola; Pasulo, Luisa; Fagiuoli, Stefano; Di Benedetto, Clara; Donato, Maria Francesca; Magro, Bianca; Pagano, Duilio; Bhoori, Sherrie; Mazzaferro, Vincenzo; Lauterio, Andrea; De Carlis, Luciano; Forastiere, Domenico; Rendina, Maria; Angrisani, Debora; Lanza, Alfonso Galeota; Scandali, Giulia; Baroni, Gianluca Svegliati; Piano, Salvatore; Angeli, Paolo; Manuli, Chiara; Martini, Silvia; De Simone, Paolo; Vacca, Pier Giuseppe; Ghinolfi, Davide; Lionetti, Raffaella; Giannelli, Valerio; Mameli, Laura; Fornasiere, Ezio; Toniutto, Pierluigi; Biolato, Marco; Ponziani, Francesca Romana; Lenci, Ilaria; Ferrarese, Alberto; Passigato, Nicola; Marenco, Simona; Giannini, Edoardo; Ferri, Flaminia; Trapani, Silvia; Grossi, Paolo; Aghemo, Alessio; Zanetto, Alberto; Russo, Francesco Paolo; Vivian, Laura Marta; Schiavone, Silvia; Colledan, Michele; Loglio, Alessandro; Viganò, Raffaella; Belli, Luca Saverio; Castellaneta, Antonino; Calleri, Alberto; Carrai, Paola; Adorno, Enzo; Agnes, Salvatore; Baccarani, Umberto; Caccamo, Lucio; Carraro, Amedeo; Cescon, Matteo; Cillo, Umberto; Di Benedetto, Fabrizio; Ettorre, Giuseppe Maria; Grattadauria, Salvatore; Pinelli, Domenico; Romagnoli, Renato; Rossi, Massimo; Tandoi, Francesco; Tisone, Giuseppe; Vennarecci, Giovanni; Vivarelli, Marco; Zamboni, Fausto. - In: JHEP REPORTS. - ISSN 2589-5559. - (2025). [10.1016/j.jhepr.2024.101278]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1731315
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