Liver transplantation for hepatitis D virus/hepatitis B virus coinfection in Italy: An intention-to-treat analysis of long-term outcomes

Patients with hepatitis D virus (HDV)/hepatitis B virus (HBV)-related end-stage liver disease candidates for liver transplantation (LT) have traditionally been regarded as a special population, although their outcomes are controversial. An intention-to-treat (ITT) analysis of long-term outcomes of HDV/HBV-coinfected patients waitlisted for LT in Italy, between 2011 and 2020, was performed and compared with HBV-monoinfected LT candidates. Of 1731 HBV-infected LT candidates, 1237 (71.5%) had HBV monoinfection and 494 (28.5%) HDV/HBV coinfection. At listing, HDV/HBV-coinfected patients were significantly younger, listed mainly for decompensated cirrhosis, and with fewer hepatocellular carcinoma (HCC) cases; (26% vs 65.8%; P <.0001) compared with HBV-monoinfected patients. HDV/HBV-coinfected patients showed better 5-year ITT survival (83.2%; 95% CI: 79.4%-83.4%, vs 71.6%; 95% CI: 68.8%-74.2%; P < .0001). ITT-multivariable analysis identified the presence of HCC, advanced recipient age, and high model for end-stage liver disease-Na scores as mortality risk factors. Five years after LT, 99.1% of HDV/HBV-coinfected patients received oral nucleos(t)ide analogs, with immunoglobulins against antigen of the hepatitis B virus in 91.8% of cases. HBV and HDV viral recurrences were 1.1% and 0.2%, respectively, whereas recurrent or de novo HCC were 8.9% and 0.3%, respectively. In Italy, HDV/HBV-coinfected patients waitlisted for LT showed more favorable outcomes compared with HBV-monoinfected patients, both before and after LT. These excellent results, from the largest cohort reported so far, suggest that HDV/HBV-coinfected LT recipients do not represent a risky population and may be considered for simpler long-term antiviral prophylactic strategies.

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Publication Details

Journal
American Journal of Transplantation
Published
2025-03-07
DOI
https://doi.org/10.1016/j.ajt.2025.03.003
Citations
2
Primary Topic
Hepatitis B Virus Studies
Type
article
Field-Weighted Citation Impact
2.71
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article

Liver transplantation for hepatitis D virus/hepatitis B virus coinfection in Italy: An intention-to-treat analysis of long-term outcomes

Davide Ghinolfi, Antonio Grieco, Flaminia Ferri, Roberta Angelico et al.
2 citations
American Journal of Transplantation
Hepatitis B Virus Studies
2.71
article

Liver transplantation for hepatitis D virus/hepatitis B virus coinfection in Italy: An intention-to-treat analysis of long-term outcomes

Davide Ghinolfi, Antonio Grieco, Flaminia Ferri, Roberta Angelico, Adriano Pellicelli, Paolo Grossi, Giovanni Vennarecci, Mauro Viganò, Renato Romagnoli, Fabrizio Di Benedetto, Patrizia Burra, Enzo Andorno, Umberto Cillo, Nicola De Maria, Maria Rendina, Francesco Paolo Russo, Matteo Cescon, Luciano De Carlis, Maria Francesca Donato, Amedeo Carraro, Salvatore Gruttadauria, Ilaria Lenci, Tommaso Maria Manzia, D. Pinelli, Giuseppe Tisone, M. Colledan, M. Angélico, Sherrie Bhoori, Vincenzo Mazzaferro, Pierluigi Toniutto, Paolo De Simone, Mario Rizzetto, Laura Turco, Silvia Trapani, Massimo Rossi, Paola Carrai, Andrea Ricci, Umberto Baccarani, Giuseppe Feltrin, Laura Schiadà, Giuseppe Maria Ettorre, L. Caccamo, Alessandra Nardi, Francesco Tandoi, L Belli, S. Agnes, Simona Marenco, Alfonso Galeota Lanza, Marco Vivarelli, Silvia Martini
article en
2 citations

Abstract

Patients with hepatitis D virus (HDV)/hepatitis B virus (HBV)-related end-stage liver disease candidates for liver transplantation (LT) have traditionally been regarded as a special population, although their outcomes are controversial. An intention-to-treat (ITT) analysis of long-term outcomes of HDV/HBV-coinfected patients waitlisted for LT in Italy, between 2011 and 2020, was performed and compared with HBV-monoinfected LT candidates. Of 1731 HBV-infected LT candidates, 1237 (71.5%) had HBV monoinfection and 494 (28.5%) HDV/HBV coinfection. At listing, HDV/HBV-coinfected patients were significantly younger, listed mainly for decompensated cirrhosis, and with fewer hepatocellular carcinoma (HCC) cases; (26% vs 65.8%; P <.0001) compared with HBV-monoinfected patients. HDV/HBV-coinfected patients showed better 5-year ITT survival (83.2%; 95% CI: 79.4%-83.4%, vs 71.6%; 95% CI: 68.8%-74.2%; P < .0001). ITT-multivariable analysis identified the presence of HCC, advanced recipient age, and high model for end-stage liver disease-Na scores as mortality risk factors. Five years after LT, 99.1% of HDV/HBV-coinfected patients received oral nucleos(t)ide analogs, with immunoglobulins against antigen of the hepatitis B virus in 91.8% of cases. HBV and HDV viral recurrences were 1.1% and 0.2%, respectively, whereas recurrent or de novo HCC were 8.9% and 0.3%, respectively. In Italy, HDV/HBV-coinfected patients waitlisted for LT showed more favorable outcomes compared with HBV-monoinfected patients, both before and after LT. These excellent results, from the largest cohort reported so far, suggest that HDV/HBV-coinfected LT recipients do not represent a risky population and may be considered for simpler long-term antiviral prophylactic strategies.

American Journal of TransplantationVol. 25(7)
Università Cattolica del Sacro Cuore (IT), University of Pisa (IT), University of Insubria (IT), University of Rome Tor Vergata (IT), University of Verona (IT), Marche Polytechnic University (IT), University of Udine (IT), University of Padua (IT), Second Military Medical University (CN), Policlinico Umberto I (IT), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Antonio Cardarelli (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), Fondazione Ricerca Molinette (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Ospedale Papa Giovanni XXIII (IT), Fatebenefratelli Hospital (IT), Azienda Ospedaliero Universitaria Ospedali Riuniti (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Azienda USL di Bologna (IT), Eastern Hepatobiliary Surgery Hospital (CN), Ospedale Policlinico San Martino (IT), University of the Sacred Heart (JP), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Azienda Ospedaliera Universitaria Pisana (IT), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Turin (IT), University of Bari Aldo Moro (IT), University of Genoa (IT), Sapienza University of Rome (IT)
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Hepatitis B Virus Studies
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