Prophylaxis against hepatitis B virus recurrence after liver transplantation for hepatitis B virus-related end-stage liver diseases with severe hypersplenism and splenomegaly: Role of splenectomy

Background: The role of splenectomy on prophylaxis against hepatitis B virus (HBV) recurrence after liver transplantation (LT) for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly remains unclear today. Methods: A total of 510 consecutive patients with HBV-related end-stage liver diseases who underwent LT in Liver Transplantation Center, West China Hospital, Sichuan University (Chengdu, China) between June 1999 and October 2009 were studied retrospectively in this study. Patients were divided into three groups in this study: splenectomized group (group A, n = 137), including preoperatively splenectomized subgroup (group A1, n = 48) and intraoperatively splenectomized subgroup (group A2, n = 89); nonsplenectomized group with severe hypersplenism (group B, n = 95); and nonsplenectomized group without severe hypersplenism (group C, n = 278). The incidence of posttransplant rejection, posttransplant infection, posttransplant hepatic cell carcinoma recurrence rate, and HBV recurrence rate were recorded. The end of the follow-up period was October 2010. Results: In this study, six patients with HBV recurrence were found in group A, 15 cases in group B, and 13 cases in group C during the follow-up period. (1) The incidence of posttransplant rejection in patients of group A was significantly lower than that in group B (P = 0.0023) and also the HBV recurrence rates in group A markedly decreased (P = 0.004). (2) The incidence of posttransplant rejection in group A was significantly lower than that in group C (P = 0.0433); however, the incidence of posttransplant infection in group A largely increased compared with that in group C (P = 0.0233). The HBV recurrence rates between group A and group C had no significant difference (P = 0.804). (3) The HBV recurrence rates in group B were significantly higher than that in group C (P = 0.001). Conclusions: The results of this study showed that splenectomy could significantly reduce the incidence of posttransplant rejection and HBV recurrence rate for the patients undergoing LT for HBV-related end-stage liver diseases with severe hypersplenism and splenomegaly. (C) 2012 Elsevier Inc. All rights reserved.