Long-term post-transplant outcomes in patients with hepatitis D virus infection at a high-volume liver transplant center

Abstract

Background and Aims Hepatitis D virus (HDV) infection remains a major cause of liver failure in T & uuml;rkiye, yet post-transplant outcomes and recurrence predictors are not well defined. This study aimed to evaluate long-term outcomes and risk factors for HDV recurrence following liver transplantation in a high-volume transplant center. Methods We retrospectively analyzed 182 patients who underwent liver transplantation for HDV-related liver disease between 2010 and 2024. Clinical, virological, and survival data were compared between patients with and without HDV recurrence. Kaplan-Meier survival and Cox regression analyses were performed to identify independent predictors of recurrence. Results HDV recurrence occurred in 12 patients (6.6%) during a median follow-up of 80 months. HBIG administration significantly reduced recurrence risk (HR = 0.001, p < 0.001), while post-transplant HBV recurrence was strongly associated with HDV relapse (p < 0.001). Pre-transplant hepatocellular carcinoma (HCC) showed no significant association with HDV recurrence. Overall survival did not differ significantly between recurrence and non-recurrence groups (p = 0.068). Conclusions Our results showed that HDV recurrence was infrequent and was not associated with a statistically significant difference in post-transplant survival. Post-transplant HBV recurrence and HBIG therapy were identified as the main factors influencing HDV recurrence. Another important finding was that pre-transplant hepatocellular carcinoma (HCC) was not significantly associated with HDV recurrence. These results provide valuable long-term evidence from an HDV-endemic region and may guide post-transplant management strategies.