PROOF 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 Abstract Objectives: Despite living-donor liver transplant being a life-saving therapy for patients with hepatitis B virus with or without hepatocellular carcinoma, outcomes for patients with these diseases are worse. Hepatitis B virus recurrence or relapse of hepatocellular carcinoma can result in subsequent graft loss or patient death. In this study, we discuss the postoperative outcomes of patients with hepatitis B virus infection after living-donor liver transplant. Materials and Methods: We retrospectively analyzed 125 patients with hepatitis B virus-related end-stage liver disease, comparing results with 1228 control patients who had other pathologies, including hepatitis C virus, combined hepatitis B virus and hepatitis C virus, and neither virus. Results: Survival rates of patients with hepatitis B virus did not differ from the control groups (P > .05). Patients with concurrent hepatitis B virus and hepatocellular carcinoma were significantly older (P < .0001), had critical status (P < .0001), had chronic underlying pathology (P = .001), lower graft-to- recipient body weight ratio (P = .047), needed more intraoperative plasma transfusion, and experienced more rejection episodes than those without hepatocellular carcinoma. Of interest, in 5 patients who had hepatitis B virus recurrence after living-donor liver transplant, Model for End-Stage Liver Disease score was significantly higher than those who did not have recurrence (P = .015). In addition, 2 patients had hepatocellular carcinoma recurrence in the form of peritoneal metastasis, with both patients having high preoperative alpha-fetoprotein levels. Conclusions: Our study provides details on long-term outcomes of patients with hepatitis B virus infection who had undergone living-donor liver transplant. Based on our results, we suggest that prolonged antiviral prophylactic therapy in the form of hepatitis B immunoglobulin with either lamivudine or entecavir be considered for patients with associated with risk factors to prevent postoperative recurrence. Key words: Hepatitis C virus, Hepatocellular carcinoma, Recurrence Introduction In Asia, particularly in Japan, living-donor liver transplant (LDLT) is considered the treatment of choice for patients with end-stage liver disease resulting from hepatitis B virus (HBV) infection. 1,2 Hepatocellular carcinoma (HCC) is a common sequel of chronic HBV, which can also be successfully treated with LDLT. 3-5 Hepatocellular carcinoma recurrence after LDLT has long been recognized as a reason for high patient mortality. 6-8 In addition, the risk of HBV reinfection after LDLT can be minimized by efficient combinations of therapeutic prophylactic agents. 9-13 However, emergence of drug mutations, such as emergence of the HBV polymerase gene locus known as tyrosine-methionine-aspartate-aspartate (YMDD), can result in resistance to the commonly used HBV prophylactic agents, including the purine nucleoside analog reverse-transcriptase inhibitor lamivudine. 14-16 Thus, both HCC recurrence and HBV relapse after LDLT are major complications that can affect patient mortality. However, information on the Copyright © Başkent University 2016 Printed in Turkey. All Rights Reserved. Outcome of Hepatitis B Virus Infection After Living-Donor Liver Transplant: A Single-center Experience Over 20 Years Hanaa Nafady-Hego, 1,2 Hamed Elgendy, 3,4 Asmaa Nafady, 5 Shinji Uemoto 6 From the 1 Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; the 2 Department of Hematology and Immunology, Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia; the 3 Department of Anesthesia, Faculty of Medicine, Assiut University, Assiut, Egypt; the 4 Department of Anesthesiology, King Abdullah Medical City, Mecca, Saudi Arabia; the 5 Department of clinical pathology faculty of medicine Assiut University, Assiut, Egypt; and the 6 Department of Hepatobiliary Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan Acknowledgements: The authors declare that they have no conflicts of interest and received no funding for this study. Hanaa Nafady-Hego, Hamed Elgendy, Asmaa Nafady, and Shinji Uemoto carried out the research. Hanaa Nafady-Hego, Hamed Elgendy, Asmaa Nafady, and Shinji Uemoto wrote the paper. Hanaa Nafady-Hego, Hamed Elgendy, and Shinji Uemoto participated in research design. Hanaa Nafady-Hego conducted the data analysis. Shinji Uemoto directed the transplant program. Corresponding author: Hanaa Nafady-Hego, Hepatobiliary Pancreatic Surgery and Transplantation, Graduate school of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, 606-8507-Kyoto, Japan Phone: +81 75 751 4328 Fax: 81 75 751 4328 E-mail: hanaa@kuhp.kyoto-u.ac.jp, hanaa1205@gmail.com Experimental and Clinical Transplantation (2016)