Viral Hepatitis
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2006; 12(11): 1706-1712
Published online Mar 21, 2006. doi: 10.3748/wjg.v12.i11.1706
Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease
Stefano Targhetta, Federico Villamil, Paolo Inturri, Patrizia Pontisso, Stefano Fagiuoli, Umberto Cillo, Attilio Cecchetto, Simona Gianni, Remo Naccarato, Patrizia Burra
Stefano Targhetta, Stefano Fagiuoli, Simona Gianni, Remo Naccarato, Patrizia Burra, Gastroenterology Section, Depar-tment of Surgical and Gastroenterological Sciences, University of Padova, Italy
Federico Villamil, Liver Unit, Fundacion Favaloro, Buenos Aires, Argentina
Paolo Inturri, Gastroenterology Unit, San Bonifacio Hospital, Verona, Italy
Patrizia Pontisso, Clinica Medica 5, Department of Clinical and Experimental Medicine, University of Padova, Italy
Umberto Cillo, Surgery Section, Department of Surgical and Gastroenterological Sciences, University of Padova, Italy
Attilio Cecchetto, Department of Pathology, University of Padova, Italy
Co-correspondence author: Stefano Targhetta
Correspondence to: Dr. Patrizia Burra, Department of Surgical and Gastroenterological Sciences, Gastroenterology Section, University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
Telephone: +39-49-8212892 Fax: +39-49-8760820
Received: December 2, 2005
Revised: December 17, 2005
Accepted: December 13, 2005
Published online: March 21, 2006

AIM: To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT.

METHODS: Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBV-DNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis (CH) B after LT was classified as minimal, mild, moderate or severe.

RESULTS: HBV recurred in 7/42 (16.6 %) patients after 6-96 mo of follow-up. A hundred and eighty-seven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg+/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients (7.1 %), minimal/non-specific changes were observed in 18 (64.2 %), and at least 1 biopsy showed CH in the remaining 8 (28.5 %). Twenty-nine LB obtained from 7 patients transplanted for HBV-HCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg+ or HBsAg- liver diseases.

CONCLUSION: Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

Keywords: Liver transplantation, Hepatitis B virus, Liver biopsy, Anti-HBs Immunoglobulins