Viral status at the time of liver transplantation for hepatocellular carcinoma: a modern predictor of longterm survival

ObjectivesThe impact of pre‐transplant hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC) is not well described. This study was conducted to test the hypothesis that viral status is an independent predictor of retransplantation rates, graft survival (GS) and overall survival (OS) in patients undergoing liver transplantation for HCC.MethodsPatients with HCC were identified from the Organ Procurement and Transplantation Network database (2005–2012), and categorized by viral status according to these categories: HBV−/HCV−; HBV+/HCV−; HBV−/HCV+, and HBV+/HCV+.ResultsOf 7742 patients transplanted for HCC, 7060 had known HBV and HCV status. Five‐year GS and OS were highest in recipients who were HBV+/HCV−, at 75% and 78%, respectively, compared with patients who were HBV−/HCV− (GS = 63%, OS = 66%), HBV−/HCV+ (GS = 64%, OS = 60%) or HBV+/HCV+ (GS = 60%, OS = 62%). In multivariable analyses, HBV−/HCV+ patients were more likely than HBV+/HCV− patients to undergo repeat transplantation. Patients who were HBV−/HCV+ also had poorer GS and OS than both HBV−/HCV− and HBV+/HCV− patients. Other independent predictors of poorer OS included older age, higher Model for End‐stage Liver Disease score, African‐American race, and diabetes. The few HBV+/HCV+ patients (n = 138) showed trends toward fewer retransplantations, prolonged GS and prolonged OS compared with HBV−/HCV+ patients. In adjusted models, antiviral medications did not impact GS or OS.ConclusionsIn the era of modern selection criteria, viral status is an independent predictor of outcome following liver transplantation for HCC. Both HBV−/HCV− and HBV+/HCV− patients have superior GS and OS compared with HBV−/HCV+ patients.