LIVER TRANSPLANTATION: A THERAPEUTIC OPTION FOR HEPATITIS B FLARE POST ONCO- HAEMATOLOGICAL TREATMENT

Background: Liver transplantation (LT) is the curative treatment for acute and
chronic hepatitis B virus (HBV) infections. However, LT indication becomes
challenging when HBV flare arises following chemotherapy for onco-haema-
tological diseases due to concerns about cancer recurrence. Limited outcome
data make decision-making difficult. We evaluated LT outcomes for HBV flare in
patients with recent history of onco-haematological diseases.
Methods: We reviewed cases between 2006 and 2024 to identify LT for HBV
flare following chemotherapy for onco-haematological diseases. Data included
cancer type, chemotherapy, HBV prophylaxis, donor and recipient characteris-
tics, and post-LT outcomes. Range or incidences are given.
Results: Among 730 LT cases, 5 involved HBV flare following chemotherapy for
non-Hodgkin (n=4/5) and Hodgkin lymphoma (n=1/5). Patients (aged 46–59y,
2/5 male) received rituximab-based regimens (n=4/5). One patient received
tenofovir prophylaxis for known past HBV infection. HBV flare occurred 0-2
months after chemotherapy. All patients had positive HBV DNA and complete
lymphoma response at the time of HBV flare. Antiviral treatment was unsuc-
cessful in all cases. Three patients required ICU admission, and the model for
end-stage liver disease score at LT ranged 29-40 points. All LT were performed
from brain-dead donors aged 21–81y, with cold ischaemia times ranging
202-588min. Post-LT course was uneventful, with ICU stays of 0–10 days and
hospitalization of 26–47 days. All patients received hepatitis B immunoglob-
ulin and 3 received tenofovir post-transplant. Over a median 8yr of follow-up,
no HBV recurrence occurred, and graft, patient and cancer recurrence-free
survival rates were 100%.
Conclusions: LT is a viable life-saving option for patients experiencing HBV
flare following recent onco-haematological disease with early complete remis-
sion. While our results demonstrate excellent mid-term patient and recur-
rence-free survival rates, validation of this therapeutic approach requires further
evaluation through larger, multicentre studies with longer follow-up—especially
given that these patients would otherwise face a poor prognosis.