Hepatitis B Virus Linked to Poorer Graft Survival in Liver Transplant Recipients

Strategic Insights -

Recent research has shed light on the outcomes of liver transplant recipients with hepatocellular carcinoma (HCC) in the post-DAA (direct-acting antivirals) era. A study, conducted by researchers at Beth Israel Deaconess Medical Center, found that etiologies of HCC in liver transplant recipients had a significant impact on waitlist dropout and graft survival. Specifically, those with metabolic dysfunction-associated steatotic liver disease (MASLD) had the highest dropout rates and poorest graft survival, with a 20.4% dropout rate at 1-year and 58.2% at 3-years.

Key Takeaways:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) had the highest dropout rates and poorest graft survival among liver transplant recipients with hepatocellular carcinoma (HCC).
  • MASLD-HCC was associated with worse graft survival compared to other etiologies of HCC, including hepatitis B virus (HBV).
  • The study analyzed data from the United Network Organ Sharing/Organ Procurement Transplant Network from 2015 to 2022, and used Kaplan-Meier curves and multivariate analysis to assess predictors of waitlist dropout and graft failure.
  • Among liver transplant recipients, MASLD-HCC had a higher risk of graft failure compared to other etiologies of HCC.
  • The study found that the worst graft survival in MASLD-HCC was associated with pre-liver transplant diabetes.
  • The study's findings have implications for the management and treatment of patients with MASLD-HCC and liver transplant recipients.

Statistics:

  • 53.6% of liver transplant recipients had HCV as the etiology of HCC.
  • 12.0% had alcohol-associated liver disease (ALD) as the etiology of HCC.
  • 16.6% had metabolic dysfunction-associated steatotic liver disease (MASLD) as the etiology of HCC.
  • 5.6% had hepatitis B virus (HBV) as the etiology of HCC.
  • 12.1% had other etiologies of HCC.
  • 20.4% of MASLD-HCC recipients dropped out of the waitlist at 1-year.
  • 21.7% of ALD-HCC recipients dropped out of the waitlist at 1-year.
  • 58.2% of MASLD-HCC recipients dropped out of the waitlist at 3-years.
  • 51.1% of ALD-HCC recipients dropped out of the waitlist at 3-years.

Sources:

  • European Journal of Gastroenterology & Hepatology, "Metabolic Dysfunction-associated Steatotic Liver Disease Correlates With Higher Lower Graft Survival In Liver Transplant Recipients With Hepatocellular Carcinoma." 2025;37(4):497-504.
  • Beth Israel Deaconess Medical Center, "Findings from Beth Israel Deaconess Medical Center Update Understanding of Hepatitis B Virus (Metabolic Dysfunction-associated Steatotic Liver Disease Correlates With Higher Lower Graft Survival In Liver Transplant Recipients With ...)." Cancer Weekly. May 13, 2025; p 58.