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

The long-term hepatic complications after allogeneic hematopoietic stem celltransplantation (HSCT) in hepatitis B virus (HBV) endemic area are unknown. We examined the serologicaland 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 cellsfrom donors with natural immunity to HBV had sustained serologicclearance of HBsAgafter HSCT. Eight of the 62 recipients without sustained HBsAgclearance compared with none of the 20 recipients with sustained HBsAgclearance 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 serologicclearance of HBsAgafter HSCT.