Retransplantation in hepatitis B--a multicenter experience.

Hepatitis B has become one of the most challenging diseases in liver transplantation. Infection of the allograft with subsequent graft failure is common and may prompt consideration of repeat liver transplantation. The aims of this study were to examine the experience in the United States with retransplantation in hepatitis B patients with recurrent disease as well as for other reasons. Questionnaires were mailed to adult liver transplant centers in the United States, requesting information on retransplantation in HBV patients. Responses were received from 71% of the centers. Thirty-eight patients were retransplanted, 20 for recurrent HBV and 18 for other reasons. The survival rate following retransplantation for HBV was poor. Nine patients (55%) died within 60 days. Eleven patients survived 60 days or longer, though eight died at a mean of 4.1 +/- 2 months, one required a third transplant for recurrent HBV infection at 4 months, and one died at 35 months. Only a single (5%) long-term survivor exists. Recurrent histologic disease occurred earlier in the second transplant at 2.8 +/- 2.9 months versus 6.1 +/- 5.2 months in the first allograft, though this difference did not reach statistical significance (P = .058). Patients transplanted for other reasons (primary non-function [9], hepatic artery thrombosis [6], persistent rejection [2], and a Pseudomonas graft infection [1]) had a better survival rate. Four patients survived less than 60 days. Of the 14 surviving longer than 60 days, 11 patients are alive at a mean of 21.2 +/- 14.8 months. Retransplantation for recurrent HBV appears to be contraindicated due to a high mortality. Retransplantation in HBV patients with graft failure due to other causes, however, should be considered, since over 60% of these patients appear to have good long-term survival. Additional studies examining risk factors for recurrent disease should be considered.