From the Guidelines
Hepatitis B carrier status does not significantly impact liver regeneration after liver resection in patients with well-compensated liver function and low viral loads. When considering liver resection in hepatitis B carriers, it is essential to assess liver function and viral load to determine the best course of action.
- Patients with high viral loads (typically HBV DNA >2000 IU/mL) should receive antiviral therapy with medications such as entecavir or tenofovir before surgery to prevent viral reactivation 1.
- Antiviral prophylaxis is crucial in these patients, as surgery-induced immunosuppression can trigger viral replication, potentially compromising regeneration and causing hepatic decompensation.
- The liver's regenerative capacity remains largely intact in well-compensated hepatitis B carriers, as the basic mechanisms of hepatocyte proliferation and growth factor signaling continue to function.
- However, patients with advanced fibrosis or cirrhosis due to chronic hepatitis B may experience somewhat delayed or diminished regeneration, making careful preoperative assessment of liver function essential for these patients 1.
- Factors such as cirrhosis, steatosis, and cholestasis can impair liver regeneration and increase the risk of post-hepatectomy liver failure (PHLF), highlighting the importance of thorough preoperative evaluation 1.
From the Research
Impact of Hepatitis B Carrier Status on Liver Regeneration
- Hepatitis B carrier status may have an impact on liver regeneration after resection, as studies have shown that chronic hepatitis B virus (HBV) infection can affect liver function and regeneration [ 2 ].
- A study published in the World Journal of Surgery found that HBV carriers had a more prolonged prothrombin time and fewer major resections were performed compared to non-carriers [ 2 ].
- However, the study also found that patients with chronic hepatitis B had better median disease-free survival and similar overall survival rates compared to non-carriers [ 2 ].
Perioperative Antiviral Therapy and Liver Regeneration
- Perioperative antiviral therapy has been shown to improve safety in patients with hepatitis B-related hepatocellular carcinoma (HCC) after hepatectomy [ 3 ].
- A study published in the International Journal of Surgery found that antiviral treatment reduced the incidence of hepatic insufficiency and morbidity in patients with HBV-related HCC [ 3 ].
- Another study found that tenofovir disoproxil fumarate (TDF) treatment had a significantly better overall survival and better protection of liver function compared to entecavir (ETV) treatment in patients with HBV-related HCC [ 4 ].
Liver Function and Regeneration
- Entecavir has been shown to be effective in treating chronic hepatitis B in patients with decompensated liver disease, with significant improvements in liver function and virological endpoints [ 5 ].
- A study published in the Journal of Gastroenterology found that TDF treatment had a significantly better protection of liver function and higher overall survival rates compared to ETV treatment in patients with HBV-related HCC [ 4 ].
- Liver resection is currently the mainstay of treatment for hepatocellular carcinoma (HCC), and evolving strategies and emerging therapies are being developed to improve outcome [ 6 ].