Twenty-Year Trends in Liver Transplantation Among Hepatitis D Virus–Infected Patients in the United States and Europe

Background & Aims Data on outcomes of hepatitis D virus coinfection in individuals with hepatitis B virus are limited. Clinical characteristics and post-transplant outcomes of patients with hepatitis B virus/hepatitis D virus vs hepatitis B virus monoinfection were compared. Methods Adult liver transplant recipients with hepatitis B virus infection from the European Liver Transplant Registry and the United States Scientific Registry of Transplant Recipients between 2000 and 2022 were analyzed. Listing diagnosis determined hepatitis D virus coinfection. Demographic, clinical, peritransplant characteristics, and post-liver transplant mortality were compared between the hepatitis D virus and hepatitis B virus groups. Results Among 13,093 hepatitis B virus liver transplant recipients, 2327 (18%) had hepatitis D virus. Hepatitis D virus was more frequent in the European Liver Transplant Registry (24%) vs the United States Scientific Registry of Transplant Recipients (2.6%). The proportion of hepatitis B virus/hepatitis D virus liver transplant recipients remained stable over time ( P > .05). Compared with patients with hepatitis B virus monoinfection, patients with hepatitis D virus were younger (48 ± 10 vs 54 ± 10 years), had lower body mass index (25.4 ± 4.0 vs 26.3 ± 4.7 kg/m2), were less male (68% vs 83%), were less frequently listed with hepatocellular carcinoma (27% vs 44%), had more ascites (66% vs 55%), and had higher Model for End-stage Liver Disease scores (17.6 ± 7.4 vs 17.0 ± 9.3) (all P < .01). The median follow-up was 5.2 years (interquartile range, 1.3–11.7 years). Post-liver transplant survival was superior in patients with hepatitis D virus: 1-year (92% vs 88%), 3-year (86% vs 80%), 5-year (81% vs 74%), 10-year (68% vs 61%) (all P < .01). Similar trends were noted in patients without hepatocellular carcinoma; outcomes in patients with hepatitis D virus vs patients with hepatitis B virus with hepatocellular carcinoma were similar (all P > .05). Conclusions Compared with hepatitis B virus-monoinfected recipients, hepatitis B virus/hepatitis D virus recipients were transplanted younger with more advanced liver disease, underscoring the urgent need for hepatitis D virus–targeted therapies. Despite their worse pretransplant profile, patients with hepatitis D virus achieve comparable or superior post-transplant survival.