CLINICAL ADVANCES IN LIVER, PANCREAS, AND BILIARY TRACT Hepatocellular Carcinoma Is Associated With an Increased Risk of Hepatitis B Virus Recurrence After Liver Transplantation

ackground & Aims: Hepatitis B virus (HBV) reurrence after orthotopic liver transplantation OLT) is significantly reduced by prophylaxis with yperimmune antibody to hepatitis B surface antien (anti-HBs) globulins (HBIG) and antiviral rugs. The role of hepatocellular carcinoma (HCC) n HBV recurrence remains unclear. We investiated the association between HCC pre-OLT and BV recurrence post-OLT. Methods: We studied 99 epatitis B surface antigen-positive patients who nderwent OLT for cirrhosis. The median folow-up period was 43 months. All patients received BIG, and 51 also received lamivudine and/or adfovir. Of these 99 patients, 31 had HCC before LT. Total HBV DNA and covalently closed circuar (ccc)-DNA were measured in tumor and nontuor tissues from the explanted livers of 16 of these 1 HCC patients and, also, in a context of tumor ecurrence, in 3 patients who developed HBV/HCC ecurrence. Results: Fourteen patients (14.1%) deeloped HBV recurrence within a median period of 5 months post-OLT. HCC at OLT, a pre-OLT HBV NA viral load >100,000 copies/mL, and HBIG onoprophylaxis were independently associated ith HBV recurrence post-OLT. Eleven out of the 1 patients with HCC at OLT presented with HBV ecurrence and 3 out of the 68 patients without CC had HBV recurrence (P < .0001). HBV recurence was more frequent in patients who developed CC recurrence (7/8 patients, 87.5%) than in those ho did not (4/23 patients, 17.4%) (P < .0001). In he 16 explanted livers, cccDNA was detectable in CC cells in 11 and in nontumor cells in 12. ccDNA was detected in a context of HCC recurence in 2 of the 3 patients tested who developed BV/HCC recurrence. Conclusions: The associaions of HCC pre-OLT, and HCC recurrence with BV recurrence post-OLT, and the detection of BV DNA and cccDNA in HCC suggest that HBV eplication in tumor cells may contribute to HBV ecurrence post-OLT.