To investigate postoperative hepatitis B recurrence and its risk factors in liver transplant recipients with HBV-related end-stage liver disease.

Clinical data of 138 recipients, who underwent liver transplantation for HBV-related end-stage liver disease at the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2024, were retrospectively collected. Recipients were divided into a recurrence group (n=13) and a non-recurrence group (n=125) based on the presence or absence of postoperative hepatitis B recurrence. The homogeneity of variances between the two groups was assessed using Levene′s test. When variances were equal (P>0.05), comparisons between groups were performed using the group t-test; when variances were unequal (P≤0.05), the adjusted t-test was used. For continuous data with a non-normal distribution, the Mann-Whitney U test was used for intergroup comparisons. Categorical data were compared using the chi-square test. Logistic regression analysis was used to identify risk factors for postoperative hepatitis B recurrence. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. A P-value < 0.05 was considered statistically significant.

Follow-up was conducted until December 31, 2025, with a median follow-up duration of 39.8 (7.7, 116.7) months. Statistically significant differences were observed between the two groups in mean serum tacrolimus concentration [(9.54±1.87) and (7.97±2.22) ng/mL] within the first postoperative year and the incidence [84.6%(11/13) and 53.6% (67/125) ] of postoperative complications (t=-2.461, χ²=4.609, all P<0.05). Multivariate logistic regression analysis revealed that serum tacrolimus concentration within the first postoperative year (OR=1.500, 95%CI: 1.050-2.141) was an independent risk factor for postoperative hepatitis B recurrence in HBV-related liver transplant recipients (P<0.05). The 1-, 3-, and 5-year cumulative overall survival rates for the 138 recipients were 97.8%, 90.7% and 81.7%, respectively. During follow-up, three recipients in the recurrence group died due to intrahepatic recurrence of hepatocellular carcinoma, intrahepatic hepatocellular carcinoma recurrence with pulmonary metastasis, and fulminant liver failure caused by HBV reactivation. There were 14 recipients died in the non-recurrence group: 4 died of multiple organ failure, 3 died of liver failure caused by disease progression following hepatocellular carcinoma recurrence, 3 died of liver failure secondary to immune rejection, 3 died of biliary complications, and 1 died of gastrointestinal hemorrhage. The 1-, 3-, and 5-year cumulative survival rates of recipients were 92.3%, 84.6% and 76.2% in the recurrence group, and 97.6%, 91.5% and 82.5% in the non-recurrence group. The log-rank test showed no statistically significant difference in cumulative survival was observed between the two groups at follow-up endpoint(χ²=0.709, P>0.05).

Higher mean serum tacrolimus concentration within the first postoperative year may be a risk factor for postoperative hepatitis B recurrence in liver transplant recipients with HBV-related disease.