Similar Rates of Transplant Survival Seen Among Patients With HDV, HBV

Investigators who conducted the first US-based retrospective study of the outcomes of liver transplantation among patients with both hepatitis B virus (HBV) and hepatitis delta virus (HDV) survived liver transplantation at comparable rates to those of patients with HBV monoinfection.

The researchers examined data from the period 2002-2019, evaluating posttransplant survival and identifying predictors of survival. Their study results were published in Transplantation Direct.

The lack of curative therapies for hepatitis delta virus (HDV) often leads to higher rates of hepatic decompensation and hepatocellular carcinoma (HCC) among these patients compared to patients with hepatitis B virus without HDV, the authors explained. As a result, patients with HDV are frequently sicker and more likely to be similar for liver transplantation necessitated by decompensation. These patients have been thought to be less likely to survive liver transplantation.

“We identified a total of 152 HBV/HDV and 5435 HBV patients who underwent LT. [liver transplantation],” the authors wrote. “HDV patients were younger at transplant (52 versus 55, P < 0.001), less commonly Asian (16% versus 36%, P < 0.001), more likely to be HCV Ab positive (42% versus 28%, P < 0.001), and less likely to be listed for LT with HCC (38% versus 51%, P = 0.001), more likely to have ascites (73% versus 64%, P = 0.019), had worse coagulopathy (mean INR 2.0 versus 1.82, P = 0.04), and were more likely to receive a HCV-positive donor organ (7% versus 3%, P = 0.001).”

The study revealed that overall survival posttransplant and graft survival were similar between HDV and HBV patients, including among patients with HCC. Characteristics associated with higher mortality following transplant included older age, coinfection with hepatitis C virus, and HCC.

“HDV patients were sicker and more likely to be listed for LT for decompensated disease compared with HBV patients,” the authors wrote. “Post-LT survival was similar between HDV and HBV patients, in contrast to prior international studies that suggested worse post-LT survival in HBV patients due to higher rates of HBV reactivation.”

—Rebecca Mashaw

Reference:

Kushner T, Da BL, Chan A, Dieterich D, Sigel K, Saberi B. Liver transplantation for hepatitis D virus in the United States: A UNOS study on outcomes in the MELD era. Transplant Direct. 2021;8(1):e1253.

DOI: 10.1097/TXD.0000000000001253