Alcoholic Liver Disease Worsens HBV Reactivation in Liver Transplant Patients

A recent study published in Engineering has revealed the impact of alcoholic liver disease (ALD) on post-transplant hepatitis B virus (HBV) reactivation and survival outcomes in patients with hepatocellular carcinoma (HCC). The research, conducted by a team of medical experts from various institutions in China, emphasizes the significant role of ALD in exacerbating HBV reactivation and worsening surgical outcomes in liver transplant recipients with a history of HBV infection.

The study analyzed 453 liver transplant recipients with HBV-related HCC, of whom 113 had ALD and HBV infection, while 340 had HBV infection alone. Patients with ALD had a higher risk of HBV reactivation and liver metastasis. The five-year HBV reactivation-free survival rate was lower in the ALD group (74.9%) compared to the non-ALD group (85.4%). Overall survival and tumor recurrence-free survival were also lower in the ALD group.

A machine learning approach predicted post-transplant HBV reactivation using the surv.cforest model, outperforming the Cox model. Metabolic parameters like total cholesterol, high-density lipoprotein, and triglyceride levels were key determinants of HBV reactivation risk. The Alcohol-Modified HBV Reactivation Index (AMBRI) stratified patients into low, intermediate, and high-risk groups, with ALD strongly correlated with higher AMBRI scores.

The study highlights ALD as a significant risk factor for HBV reactivation in liver transplant recipients with HBV-related HCC. Enhanced surveillance and treatment regimens are recommended, especially for recipients with a history of ALD. Future guidelines should include metabolic parameters and ALD-related indicators for better risk prediction and management.

This study emphasizes personalized risk assessment and management strategies for optimizing clinical outcomes in liver transplant recipients.

Ethical approval for the HBV reactivation cohort was obtained from the Ethics Committee of two centers, consistent with prior research.