recurrence than patients with hepatitis D virus (HDV)-re-It has been suggested that Asian patients have related cirrhosis or patients with fulminant HBV infection. 3-5 duced survival after liver transplantation because of It has also been reported that the rate of HBV recurrence is greater recurrence of hepatitis B virus (HBV). We anahigher in cirrhotic patients with active viral replication than lyzed the outcome of Asian and non-Asian patients rein patients negative for serum HBV DNA and hepatitis B e ceiving transplants for chronic hepatitis B between May antigen (HBeAg). 5 In addition, it has been suggested that 1988 and March 1994. Baseline Child-Pugh score and Asian patients may have reduced survival after OLT because United Network for Organ Sharing (UNOS) status, HBV of a higher HBV recurrence rate. 6,7 We reviewed our institurecurrence, and survival were compared between the tional experience to analyze potential differences in HBV retwo groups. All but one patient received variable doses currence and mortality between Asians and non-Asians unof hepatitis B immune globulin. Mean follow-up of surdergoing OLT for chronic hepatitis B. viving patients was 28 months (range, 3-71 months). Fifteen Asians and 20 non-Asians underwent transplanta-PATIENTS AND METHODS tion. Six of 15 Asians (40%) and 4 of 20 non-Asians (20%) died during the study period. Although Asians had a Medical records of all chronic hepatitis B patients who underwent OLT between May 1988 and March 1994 were reviewed retrospec-lower 1-year survival than non-Asians (59% for Asians tively. Patients with fulminant HBV infection and hepatocellular and 94% for non-Asians), the 5-year actuarial survival carcinoma were excluded. The following data were collected for each was not different (59% and 57% for Asians and nonpatient: preoperative viral serology, Child-Pugh score and United
Asians, respectively). The causes of death in 5 of 6 Asians Network for Organ Sharing (UNOS) status on referral and at the were factors other than recurrent hepatitis B, and 4 of time of OLT, date of reappearance of hepatitis B surface antigen 5 deaths occurred within 60 days after transplantation. (HBsAg), date and reason for retransplantation, and date and cause Eighty percent of Asian patients were Child-Pugh class of death. The revised UNOS status was used-status 1, hospitalized C at referral, compared with 50% of non-Asians, and in intensive care unit; status 2, continuously hospitalized; status 3, Asians were more likely to be status 1 at transplantation home and requiring continuous medical care; and status 4, home and functioning normally. No patient received a donor organ that curves was calculated using the Kaplan-Meier method.
Results
Abbreviations: OLT, orthotopic liver transplantation; HBV, hepatitis B virus; HDV, hepatitis D virus; HBeAg, hepatitis B e antigen; UNOS, United Network for Organ Sharing;
Fifteen Asian and 20 non-Asian patients underwent OLT HBsAg, hepatitis B surface antigen; anti-HBc, antibody to hepatitis B core antigen; HBIG, for chronic hepatitis B during the study period. Overall, 6 of hepatitis B immune globulin; anti-HDV, HDV antibody; UCLA, University of California at 15 Asians (40%) and 4 of 20 non-Asians (20%) died during Los Angeles.