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Introduction

HBV remains a common indication for liver transplantation (LT), which is the best therapeutic option in patients with end-stage liver disease and unresectable hepatocellular carcinoma (HCC). High barrier nucleos(t)ide analogues (NAs) have significantly modified the natural history of HBV-related liver disease both before and after LT.

Aims & Methods

Our aim was to assess the evolution of the management of patients waitlisted for HBV relatively to the introduction of NAs and to evaluate long-term patient survival after LT.
All HBsAg positive adults listed for LT at Padua University Hospital between 01.2006 and 12.2020 were retrospectively evaluated. Patients were divided according to their indication for LT (decompensated cirrhosis vs. HCC). Patient survival was calculated using Kaplan-Meier curves and comparisons between different groups were performed using LogRank.

Results

From January 2006 to December 2020, 1555 patients were waitlisted for LT, among which 284 patients were HBsAg positive, and 32.6% of them were HDV co-infected. Decompensated disease as indication to WL inclusion was slightly more common in non-HBV than HBV patients, although the difference was not statistically significant (56.7% vs 62.3%, p=0.079). The prevalence of HCC was statistically higher in the HBV cohort than in HBsAg-negative patients (p=0.008). HDV co-infected patients presented significant lower rate of HCC (22% vs. 66%, p<0.001) and significant lower rate of HCC as indication to WL (17.2% vs. 52.6%, p<0.001) than HBV mono-infected patients. HBV patients had a similar outcome during WL in terms of likelihood of LT, de-listing rate and death than non-HBV patients. HBV patients under high-barrier NAs had significantly lower WL mortality (p=0.041) and significantly higher survival after inclusion in the WL (p=0.018). After LT, all HBV patients were treated with the combination therapy of NUCs and HBIG, except for 2 patients who were treated with NAs only. We experienced only 2 cases of transient HBV relapse, without clinical sequelae. The overall survival rate after LT was 83.5% at 1 year and 5 years. No significant difference was observed between patients transplanted for decompensated cirrhosis or HCC.

Conclusion

HBV is a stable indication to LT. The introduction and spreading of NAs significantly reduces mortality and improves patient survival after inclusion in the waiting-list for LT.

THE IMPACT OF NUCLEOS(T)IDE ANALOGUES ON THE WAITING LIST FOR LIVER TRANSPLANTATION IN A SINGLE TERTIARY CENTER

Sara Battistella 1, Alberto Zanetto 1, Martina Gambato 1, Giacomo Germani 1, Marco Senzolo 1, Umberto Cillo 2, Alessandro Vitale 2, Enrico Gringeri 2, Patrizia Burra 1, Francesco Paolo Russo 1

1 Gastroenterology and Multivisceral Transplant Unit - University of Padova, Padova, Italy

2 Hepatobiliary Surgery and Liver Transplantation Unit - University of Padova, Padova, Italy

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Oncology, transplantation and encephalopathy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Mistakes in liver transplantation and how to avoid them

Alberto Zanetto, Patrizia Burra

Topics

Hepatobiliary Surgery

Citation

Burra P and Zanetto A. Mistakes in liver transplantation and how to avoid them. UEG Education 2020; 2020: 1–6.

Published

2020

UEG Presentation

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Expanding indication of liver transplantation in HCC

Filomeno Martínez 1

1 Virgen del Rocío University Hospital, Seville, Spain

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Digestive Oncology Hepatobiliary

Session

Hepatocellular carcinoma: All you need to know

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Hepatocellular carcinoma (HCC) is one of the main indication for liver transplantation (LT) worldwide, however, despite various proposed selection criteria, HCC recurrence rate after LT remains up to 20%. An earlier diagnosis allows for more effective treatments and survival benefit. Recently, the RETREAT score has been proposed showing high accuracy.

Aims & Methods

Our aim was to validate the RETREAT score in a single center cohort.
This is a retrospective study including patients who underwent LT for HCC at Padua University-Hospital between January 2016 and December 2018. Clinical and radiological data before and after LT (aFP, liver function according to MELD and CHILD score, tumor morphology, downstaging and/or bridging treatments) and explant pathology features were collected. RETREAT and TTV/aFP scores, based on explant pathology, were calculated. Cox regression and LogRank models have been used for the association between HCC scores and tumor recurrence.

Results

During the study period, 123 patients underwent LT for HCC (HCV 35%, median MELD 11). After HCC diagnosis, 115 patients (93%) underwent downstaging (47% ≥2 treatments), and 64 of them (56%) received bridging therapies. The median aFP at LT was 4.8 ng/mL. On explant pathology, microvascular invasion was found in 27%, G3 nodules in 30%. On explant pathology, 65 patients (53%) were Milan-out, 44 patients (36%) were TTV/aFP-out, 77 patients (62%) had a RETREAT score ≥2. During the follow-up of 50 months (IQR 39-60), 16 patients (13%) showed post-transplant HCC recurrence, at median time of 14 months (IQR 8-36); 75% of them had extrahepatic recurrence. RETREAT score was associated with the risk of HCC recurrence (p<0.001, HR 1.703, 95%CI 1.30-2.22). Patients with RETREAT score 0-1, 2-4 and 5-8 had a 1 year-HCC recurrence of 2%, 4% and 21%, respectively (log-rank<0.001). TTV/AFP has not been associated with HCC recurrence (p=0.680).

Conclusion

RETREAT score is a reliable tool to improve the selection of patients at higher risk of HCC recurrence and to guide the post-LT management, defining shorten tumor surveillance post-LT. Thus, an earlier diagnosis of tumor recurrence might allow more efficacious treatments and patient survival benefit.

HCC RECURRENCE AFTER LIVER TRANSPLANTATION: THE VALIDATION OF RETREAT SCORE IN A SINGLE CENTER COHORT

Sara Battistella 1, Alberto Zanetto 1, Filippo Pelizzaro 1, Marco Senzolo 1, Giacomo Germani 1, Alessandro Vitale 2, Enrico Gringeri 2, Umberto Cillo 2, Francesco Paolo Russo 1, Patrizia Burra 1, Martina Gambato 1

1 Gastroenterology and Multivisceral Transplant Unit - University of Padova, Padova, Italy

2 Hepatobiliary Surgery and Liver Transplantation Unit - University of Padova, Padova, Italy

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Prognosis and prediction in liver disease (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Q&A Fulminant hepatitis, liver failure and liver transplantation

Patrizia Burra 1, Audrey Coilly 2, Isabel Conde 3, Christian Lange 4, Sabine Weber 5

1 University of Padua-Multivisceral Transplant Unit- Gastroenterology, Padova, Italy

2 Hôpital Paul Brousse, Villejuif, France

3 Consorcio Hospital General Valencia (Spain), Valencia, Spain

4 Klinikum rechts der Isar, München, Germany

5 LMU Klinikum, Munich, Germany

Event

UEG Postgraduate Teaching Programme 2023

Topics

Hepatobiliary

Session

Fulminant hepatitis, liver failure and liver transplantation

Published

2023

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Introduction

Liver transplantation (LT) is a potentially life-saving treatment for patients with end-stage liver disease, particularly acute-on-chronic liver failure (ACLF) patients due to high mortality rates.

Aims & Methods

Aims: This study aimed to characterize the population and outcomes of patients with ACLF undergoing LT, as well as to identify factors associated with worse prognostic. Methods: Retrospective cohort study including 155 consecutive LTs performed in a Tertiary Center, between January 2020 and December 2022. ACLF was defined according to the EASL-CLIF consortium definitions. The statistical analysis was performed with the SPSS software v28.

Results

A total of 155 patients received a LT, including 25 with ACLF (16.1%). Of these, 16 (64%) had ACLF-1, 3 (12%) ACLF-2, and 6 (24%) ACLF-3, with renal dysfunction being the most common organ failure (27%). Mean age 55 years (80% male). The most frequent etiology of cirrhosis was alcohol (80%). In 68% of patients, at least 1 precipitating event was identified, with infections being the most frequent one (56%). The 1-year mortality rate after LT was 22%. No statistically significant factors associated with mortality were identified, however, spontaneous bacterial peritonitis as a precipitating event of ACLF showed a strong association with death (p=0.08).

Conclusion

ACLF is a growing indication for LT, comprising 1 in every 6 patients transplanted in this cohort. Our results suggest that renal failure and infections should be carefully managed in cirrhotic patients to avoid progression to ACFL. No predictors of post-LT mortality were identified.

ACUTE-ON-CHRONIC LIVER FAILURE AND LIVER TRANSPLANTATION: A TERTIARY REFERRAL CENTER EXPERIENCE

Luís Santos 1, Carlos Borges Chaves 1, Ana Torres Oliveira 2, David Perdigoto 3, Suzana Calretas 4, Dario Gomes 3, Pedro Narra Figueiredo 3, Dulce Diogo 2

1 Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

2 Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

3 Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal|||Faculty of Medicine, University of Coimbra, Coimbra, Portugal

4 Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal|||Faculty of Medicine, University of Coimbra, Coimbra, Portugal