Why is surgery contraindicated in patients with Hepatitis?

Surgical liver transplantation(Orthotopic liver transplantation) has been effective for hepatic diseases and one of the major indications for liver transplantation is end stage Hepatitis B infection. However, recurrence rate of Hepatitis B after liver transplantation is 80%, leading to hepatic failure, re-infection or even death of the patient (Zhu, 2001).

*Study conducted at Sun-Yat-Sen University of Medical Sciences, Guangzhou China.Zhu X.et al.Prevention and Treatment of Hepatitis B relapse after liver transplantation.Chinese Medical Journal.2001.vol 114,no.1,pp 73-75.

In the said study, 9 out 10 subjects had a 10 day to 12 week history of hepatitis B infection prior to transplantation. Post transplantation, 2 had acute renal failure and upper gastrointestinal bleeding and 8 had hepatic encephalopathy. All of them showed positive Hepatitis B antigen in their blood stream.

Hepatitis B recurrence in post-transplant patients may be due to the use of immunosuppresive drugs or re-infection with Hepatitis B virus from blood and extra-hepatic tissues of the recipient. Earliest noted case of recurrence of hepatitis B was within 1.5 months after liver transplantation.

In another study, studies showed recurrence of Hepatitis C infection after liver transplantation. Recurrence of hepatitis showed substantial mortality and morbidity with 30% of patients showing cirrhosis within the 5th year after surgery. Risk of hepatic decompensation is 40% per year (Bhat, 2009).

*Bhat, I. Hepatitis Infection after liver transplantation. Section of Gastroenterology and Hepatology, Nebraska Medical Center, Omaha, NE 68198-3285, USA.

Risk factors associated with accelerated disease recurrence are elevated high viral load prior to transplantation, older donor age, prolonged ischemic time, cytomegalovirus co-infection, intensity of immunosuppression and HIV co-infection. Although the mechanisms of accelerated HCV-induced liver damage after transplantation are poorly understood, strategies employed to limit severe recurrence include avoidance of older donors, early recognition of cytomegalovirus, minimization of immunosuppression, particularly T-cell depleting therapies and pulsed steroids for acute cellular rejection.