# Impact of HDV infection on post-transplant outcomes in patients transplanted for HBV-related liver disease: results from a multicenter cohort study in Southern Italy

## TL;DR

This study found that HDV infection does not worsen liver transplant outcomes, while chronic kidney disease at the time of transplant is a major risk factor for mortality and complications.

## Contribution

The study provides new evidence that HDV infection does not negatively impact post-transplant outcomes, challenging prior assumptions.

## Key findings

- HDV infection was not associated with worse post-transplant outcomes compared to HBV alone.
- Chronic kidney disease at the time of transplantation was the strongest predictor of mortality and clinical events.
- HBV-infected patients experienced more hepatic and extrahepatic clinical events than HBV/HDV-infected patients.

## Abstract

Patients with HBV and HBV/HDV infection were compared in terms of clinical outcomes after liver transplantation in a long-term follow-up.

In a multicenter retrospective study, the patients, who had received liver transplants for HBV chronic liver disease, were enrolled in a long-term follow-up (1–20 years). The primary outcome was overall survival, the secondary outcome occurrence of clinical events.

A total of 257 patients were enrolled, 95 with HBV (HBV group) and 162 with HBV/HDV (HBV/HDV group) infection. Overall, 31 patients died in the follow-up, most frequently due to extrahepatic events. Overall mortality was similar between the two groups (15.8% in HBV vs 9.9% in HBV/HDV group), while deaths from hepatic events were more frequent in the first group (7.4 vs. 1.2%, p = 0.014). In multivariable logistic regression analysis only a history of chronic kidney disease (CKD) at the time of transplantation emerged as independent factor associated with death (OR 7.027, 95% CI 2.068–23.876; p = 0.002).

Overall, 84 patients experienced at least one clinical event, mainly onset of renal failure (57 cases), cancer (32) and hepatic clinical (19). Compared with HBV/HDV group, clinical events occurred more frequently in HBV group (44.2 vs. 25.9%; p = 0.003), both hepatic and extrahepatic (11.6 vs. 4.9%, p = 0.050; 35.8 vs. 23.5%, p = 0.034, respectively). In multivariable logistic regression analysis, HBV group (OR 2.243, 95% CI 1.172–4.293; p = 0.015) and CKD at the time of transplantation were associated to the occurrence of clinical events (OR 8.890, 95% CI 2.373–33.306; p = 0.001).

In this long-term follow-up study, HDV infection was not associated to a worsen post-transplant outcomes, while chronic kidney disease at transplantation emerged as the strongest predictor of mortality and clinical events.

The online version contains supplementary material available at 10.1007/s15010-025-02707-5.