We have studied the roles of immunoprophylaxis, patient selection policy and coexistent hepatitis D virus
infection in the outcome of 56
HBsAg-positive elective
liver transplant recipients. Twenty-nine unselected patients not treated with immunoprophylaxis formed group 1 and were compared to a recent consecutive series of 27 patients (group 2) in whom pre-transplant serological status was determined and who received immunoprophylaxis. One-year actuarial
HBsAg serological recurrence rates were 48% in group 2 and 90% in group 1 with particular improvement in recipients who were either HBV
DNA-negative or who had co-existent hepatitis delta virus
infection. One-year patient survival has improved from 62% in group 1 to 86% in group 2 with improvements in hepatitis delta virus-negative and replicating recipients. Patients who have either co-existent hepatitis delta virus
infection or are in group 2 have 1-year survival rates comparable to elective
HBsAg-negative recipients (19/21 (90%), 22/27 (86%) vs 87%, respectively). In the event of recurrence, severe graft injury is diminished in recent patients and in those with coexistent
delta infection who also have lower levels of circulating HBV
DNA. Retransplantation for associated graft injury has a poor prognosis irrespective of administration of immunoprophylaxis. In elective liver recipients, immunoprophylaxis and/or hepatitis delta virus
infection modulate hepatitis B virus recurrence and associated graft injury with consequent improvement in patient survival.