‘EUROHEP’ consensus report on the management of liver transplantation for hepatitis B virus infection

With the improvement in survival following orthotopic liver transplantation, such that 1-year survival rates greater than 80"/0 should be considered readily attainable, attention has focused on subgroups of patients in whom the prognosis is particularly poor. It has become clear that the results of transplantation in patients with chronic hepatitis B virus (HBV) infection, whether or not complicated by hepatocellular carcinoma, are very much inferior to those results obtained in other liver disorders. Ironically, chronic HBV infection is one of the major causes of liver disease world-wide and could be one of the commonest indications for liver transplantation. In order to identify whether, amongst patients with chronic HBV infection, it was possible to distinguish patients who would do well from those who would do badly, the EUROHEP Group recently undertook an analysis of all the patients who had been transplanted for hepatitis B-related disorders throughout the European Community. Three hundred and seventy-two patients were entered into this analysis, which has allowed adequate analysis of the risk factors for graft dysfunction to be identified and for some positive recommendations to be made. It is noteworthy that the data accumulated are entirely consistent with the previous publications in smaller series of patients from both Europe and the United States of America. Patients with acute HBV infection resulting in fulminant hepatic failure, patients with end-stage liver disease as a result of chronic HBV infection and patients with endstage liver disease as a consequence of hepatitis D virus (HDV) infection superimposed upon chronic HBV infection should all be considered separately because the outcome is different for each of these three groups.