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 Blood, 15 July 2005, Vol. 106, No. 2, pp. 464-469.
Prepublished online as a Blood First Edition Paper on March 29, 2005; DOI 10.1182/blood-2005-02-0698.

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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

A long-term follow-up study on hepatitis B surface antigen–positive patients undergoing allogeneic hematopoietic stem cell transplantation

Chee-kin Hui, Albert Lie, Wing-yan Au, Yu-hung Leung, Shing-yan Ma, Winnie W. W. Cheung, Hai-ying Zhang, Chor-sum Chim, Yok-lam Kwong, Raymond Liang, and George K. K. Lau

From the Divisions of Gastroenterology and Hepatology, Hematology, and Medicine; and Centre for the Study of Liver Diseases; The University of Hong Kong, China.

The long-term hepatic complications after allogeneic hematopoietic stem cell transplantation (HSCT) in hepatitis B virus (HBV) endemic area are unknown. We examined the serological and liver-related outcome of 803 consecutive patients who received allogeneic HSCTs, with a median follow-up period of 83 months (range, 0.5-155 months). Late HBV-related hepatitis occurred in 2 of the 721 hepatitis B surface antigen–negative (HBsAg–) recipients compared with 16 of the 82 HBsAg+ recipients after HSCT (0.3% vs 19.5%; P < .001 by log-rank). Liver cirrhosis developed in 8 of the 82 HBsAg+ recipients compared with none of the 721 HBsAg– recipients (9.8% vs 0%; P < .001 by log-rank). Twenty of the 31 (64.5%) HBsAg+ recipients of hematopoietic stem cells from donors with natural immunity to HBV had sustained serologic clearance of HBsAg after HSCT. Eight of the 62 recipients without sustained HBsAg clearance compared with none of the 20 recipients with sustained HBsAg clearance developed liver cirrhosis (12.9% vs 0%; P = .02 by log-rank). Our study showed that long-term hepatic complications occur in a significant proportion of HBsAg+ patients after HSCT and the incidence of liver cirrhosis is reduced in those with sustained serologic clearance of HBsAg after HSCT.


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