70例原位肝脏移植

目的总结肝脏移植治疗不同终末期肝病的经验,探讨肝移植在治疗肝细胞癌(HCC)和重症乙型肝炎(乙肝)的疗效,以及评价拉米夫定对预防乙肝复发的价值.方法回顾性分析了自1993年4月～2000年12月实施的70例肝移植患者的临床资料.肝移植的主要指征是原发性肝癌(26例)、肝硬化(21例)、重症乙型肝炎(12例)、硬化性胆管炎(4例)以及其它终末期肝病(7例).对12例重症乙型肝炎患者应用拉米夫定治疗.采用多元回归分析确定影响肝移植预后的危险因素.结果54例患者存活1个月以上,16例患者在移植术后30d内死亡,院内存活率为77.1%,肝功能属ChildA级和B级的患者院内存活率明显高于ChildC级患者(P＜0.05),小肝癌患者的疗效优于大肝癌患者.移植前APACEⅢ评分,腹水量以及血肌酐水平与肝移植预后有密切关系.在重症乙肝患者中,9例仍存活、存活时间为2～24个月,拉米夫定可有效地预防肝移植术后乙肝复发,且无明显的副作用.结论本研究结果表明原位肝移植可使部分HCC患者获得治愈,部分病例可获得良好的姑息疗效,病例选择对肝癌肝移植的预后极其重要;结果还提示肝移植是治疗各种终末期肝病的有效手段.同时认为拉米夫定是一种疗效肯定,副作用小的预防肝移植术后乙肝病毒复发的药物.     

肝移植后乙肝复发的预防和治疗

目的 探讨原位肝移植治疗乙型肝炎相关疾病的效果及Lamivudine在防治肝移植后乙肝复发中的作用。方法　10例患者接受了原位肝移植,其中9例男性乙肝患者,1例女性为肝癌患者,术前无乙肝感染。9例乙肝患者6例并有不同程度的肝性脑病,1例并肝肾综合征,1例并上消化道大出血。9例乙肝中7例服用Lamivudine预防术后乙肝复发。结果8例存活2-15月,2例死亡。存活的8例中7例为乙肝患者,仅1例术后6月出现HBsAg（+）,但全部均肝功能良好;另1例为肝癌患者,术后出现乙肝。死亡的2例中1例为术后乙肝复发暴发性肝功能衰竭所致,另1例死于术后多器官功能衰竭。结论 原位肝移植加Lamivudine是治疗乙肝的有效方法,Lamivudine在观察期内可预防乙肝移植后乙肝复发。     

肝移植术后预防乙型肝炎复发单中心治疗方案的变迁

目的比较单中心不同年代预防肝移植术后乙型肝炎(乙肝)复发治疗方案的临床效果,总结、优化治疗方案。方法选择天津市第一中心医院器官移植中心1994年5月至2012年12月因乙肝相关良性肝病接受首次肝移植术的984例成年患者,剔除围手术期(术后30天内)死亡者62例。依据患者术后预防乙肝复发治疗方案分为未治疗组、泛昔洛韦组、拉米夫定组和核苷(酸)类似物+乙肝免疫球蛋白(HBIG)组。结果 922例患者中共有27例肝移植术后出现乙肝复发,其中3例肝移植术后未接受任何预防乙肝复发治疗的患者,均出现了乙肝复发,手术日期为1994~1999年间;术后接受泛昔洛韦治疗组患者2例,均出现乙肝复发,手术日期为1998至1999年间;单一应用拉米夫定组患者共15例,其中6例出现乙肝复发(40.0%),手术日期为1998至2001年间;1999年起接受核苷(酸)类似物+HBIG联合治疗组患者乙肝复发率为1.8%(16/902);四组患者间累积乙肝复发率差异有显著的统计学意义(χ2=48.99,P=0.000),累积存活率的差异也有显著的统计学意义(χ2=62.694,P=0.000)。结论伴随核苷(酸)类似物及HBIG的成功研制上市,我中心肝移植术后预防乙肝复发的治疗方案逐步得到优化完善,核苷(酸)类似物+HBIG联合治疗方案可有效预防肝移植术后乙肝复发,并已推广应用至全国,为肝移植术治疗乙肝相关终末期肝病提供有力保障。     

肝移植后乙肝复发的预防和治疗

目的 探讨原位肝移植治疗乙型肝炎相关疾病的效果及Lamivudine在防治肝移植后乙肝复发中的作用。方法 10例患接受了原位肝移植，其中9例男性乙肝患，1例女性为肝癌患，术前无乙肝感染，9例乙肝患6例并有不同程度的肝性脑病，1例并肝肾综合征，1例并上消化道大出血，9例乙肝中7例服用Lamivudine预防术后乙肝复发。结果 8例存活2-15月，2例死亡，存活的8例中7例为乙肝患，仅1例术后6月出现HBsAg（ ），但全部均肝功能良好；另1例为肝癌患，术后出现乙肝，死亡的2例中1例为术后乙肝复发暴发性肝功能衰竭所致，另1例死于术后多器官功能衰竭。结论 原位肝移植加Lamivudine是治疗乙肝的有效方法，Lamivudine在观察期内可预防乙肝移植后乙肝复发。     

肝癌肝移植术后肿瘤复发的防治

肝移植术是治疗肝癌的最佳方法之一,特别是在伴有肝硬化、肝功能不全或肿瘤不适合切除的情况下,肝移植具有明显的优势。早期肝癌肝移植的总体疗效优于肝癌切除。但是,肝移植后肿瘤复发仍是影响肝癌患者长期生存的主要因素。由于目前缺乏治疗肿瘤复发的有效手段,防治策略应以预防为主,兼顾治疗。肝癌肝移植术后肿瘤复发的预防应从术前、术中和术后三方面着手。     

肝癌肝移植术后肿瘤复发的治疗策略

目的比较肝癌肝移植术后肝内复发的患者分别实施肿瘤切除术、经导管肝动脉灌注化疗栓塞术（TACE）、射频消融术（RFA）、再次原位肝移植术（re—OLT）的临床疗效。方法回顾性分析我中心2004年1月至2009年6月凶肝癌行肝移植手术术后肝内复发的患者53例。其中肿瘤切除术3例,TACE22例,RFA18例,re—OLT10例,观察术前一般情况、术后生存时间、术后并发症、肿瘤进展情况、治疗费用等情况。重点对比分析TACE、RFA、re—OLT三种治疗方法的疗效。结果肿瘤切除术3例,随访4～12个月,均无手术并发症,未见肝脏及远处复发或转移,一般情况良好。TACE组、RFA组与re—OLT组的平均生存时间、累积生存率、各部位进展情况的差异无统计学意义;RFA组的并发症,特别是胆道并发症发生率比TACE组及re—OLT组低;3组的治疗费用的差异有统计学意义,RFA〈TACE〈re—OLT。结论TACE、RFA及re—OLT治疗方法对肝癌肝移植术后肝内复发的治疗效果相近。RFA的并发症及治疗费用明显少于TACE及re—OLT,可作为肝癌肝移植术后肝内复发的首选治疗方案。     

乙肝患者肝移植后乙肝复发的防治

目的 探讨原位肝移植治疗乙型肝炎相关疾病的效果及Ｌａｍｉｖｕｄｉｎｅ在防治肝移植后乙肝复发中的作用。方法 １０例患者接受了原位肝移植,其中９例男性为乙肝患者,１例女性为肝癌患者,术前无乙肝感染。９例乙肝患者６例并有不同程度的肝性脑病,１例并肝肾综合征,１例并上消化道大出。９例乙肝中７例服用Ｌａｍｉｖｕｄｉｎｅ预防术后乙肝复发。结果 ８例存活２月～１２月,２例死亡。存活的８例中７例为乙肝患者,仅１例     

乙型肝炎患者肝移植术后乙型肝炎复发的预防

目的 探索乙型肝炎DNA阳性的终末期肝病患者肝移植前快速转阴及肝移植术后复发的防治。方法 4例乙型肝炎两对半小三阳、HBV-DNA(-)的患者术前开始联合口服拉米夫定(1amivudine)及泛昔洛韦．术后3个月内治疗同前，3个月后仅口服拉米夫定维持至今；2例乙型肝炎两对半大三阳、HBV-DNA( )的患者,术前除口服拉米夫定及泛昔洛韦外，同时肌注乙肝免疫球蛋白共14d，肝移植术中无肝期快速静脉滴注15000u静脉用乙肝免疫球蛋白，术后3个月内联合口服拉米夫定及泛昔洛韦，术后3个月内治疗同前，3个月后仅口服拉米夫定维持至今。结果 1例患者术后第19天死于肺部霉菌感染,1例患者第49天死于肝动脉及门静脉栓塞；4例患者长期存活，生存时间最长的患者已接近3年，术后全部患者均未发现有乙型肝炎复发。结论 拉米夫定、乙肝免疫球蛋白及泛昔洛韦联合使用可使乙型肝炎DNA阳性的终末期肝病患者在肝移植前快速转阴，并能预防乙肝复发。     

肝移植术后肝癌复发对HBV再感染的影响

目的 探讨肝移植术后肝癌复发对HBV再感染的影响.方法 回顾性分析285例原发病为乙肝相关性疾病且术后随访超过半年的原位肝移植患者资料.结果 285例肝移植患者随访时间为6～59个月,术后HBV再感染10例,再感染率为3.5%.其中9例患者合并肝癌复发,HBV再感染发生于肝癌复发后1～7个月.肝癌复发患者与肝癌未复发和良性肝病患者HBV再感染的差异具有统计学意义.13例肝癌复发或转移灶切除标本中有1例免疫组化染色HBsAg阳性、HBcAg弱阳性.结论 乙肝免疫球蛋白联合核苷类似物是预防肝移植术后乙肝复发的有效治疗措施,肝癌复发是肝移植术后HBV再感染的重要原因.     

第003例——纳差、乏力、尿黄

病历摘要 患者男,51岁,异体肝移植术后2年8个月,因进行性黄疸到本院就诊.患者因乙型肝炎肝硬化(失代偿期)并原发性肝癌,于2004年11月行异体原位肝移植(orthotopic liver transplantation,OLT).术前查HBsAg阳性、HBcAb阳性,术后服用拉米夫定100 mg/d抗病毒治疗,并间断肌注高效价乙肝免疫球蛋白(HBIG),保持HBsAb滴度大于100 IU/L、HBsAg阴性.     

Hepatitis B Prophylaxis Using Lamivudine and Individualized Low-dose Hepatitis B Immunoglobulin in Living Donor Liver Transplantation

Background

Currently, most available experience concerning prophylaxis against hepatitis B virus (HBV) recurrence after living donor liver transplantation (LDLT) is limited to studies of small size and short follow-up. The objective of this study was to evaluate the efficacy of a prophylactic regimen using lamivudine and individualized low-dose intramuscular hepatitis B immunoglobulin (HBIG) in LDLT.

Methods

We used a database of adult-to-adult right-lobe LDLT procedures performed from June 2002 to April 2012 at our center for HBV-related end-stage liver diseases. Patients were divided into 3 groups: group A, HBV-related decompensated liver cirrhosis; group B, fulminant hepatitis B; and group C, hepatocellular carcinoma (HCC).

Results

During a mean follow-up of 38.3 ± 28.9 months, 8 of 165 (4.8%) recipients developed HBV recurrences. The mean time for HBV reinfection was 15.8 + 11.0 months after transplantation. The overall 1-, 3-, and 5-year HBV recurrence rates were 3%, 7%, and 8.2%, respectively. Both patients with fulminant hepatitis B or HCC seemed to have higher rates of HBV recurrence than those with decompensated liver cirrhosis, albeit not significantly. The independent predictor of HBV recurrence was high HBV DNA level (≥10⁵ copies/mL) at LDLT.

Conclusions

Lamivudine and individualized low-dose intramuscular HBIG provides effective prophylaxis against HBV recurrence after LDLT. Pre-LDLT HBV DNA of ≥ 10⁵ copies/mL was associated with HBV recurrence.     

173例肝移植术后乙型肝炎病毒再感染防治经验回顾

目的 探讨原位肝移植术后乙型肝炎病毒再感染的预防。方法 回顾性分析了173例乙肝相关性肝病病人，移植前后给予抗病毒药物预防乙型肝炎病毒再感染，拉米呋啶2例，拉米呋啶＋乙肝免疫球蛋白（HBIg）166例，阿德福韦＋HBIg5例，观察临床表现、血清HBV、HBVDNA及肝活检免疫组织化学检测等指标。结果 应用拉米呋啶预防的2例病人，有1例再感染，其血清HBsAg、HBeAb、HBcAb和HBVDNA均阳性，肝活检免疫组织化学检测有HBsAg表达。用拉米呋啶＋HBIg预防的166例中，有3例再感染，血清均HBsAg、HBeAb和HBcAb阳性，肝活检免疫组织化学检测有HBsAg表达，其中1例血清HBVDNA阳性，有1例经治疗后HBsAg又转阴。用阿德福韦＋拉米呋啶＋HBIg预防的5例中，血清学和肝活检免疫组织化学检测均无HBsAg表达。结论 原位肝移植术是治疗HBV相关性终末期肝病的有效手段，拉米呋啶＋HBIg或拉米呋啶＋阿德福韦＋HBIg联合应用可以有效预防乙型肝炎病毒的再感染。     

Transplantation of hepatitis B surface antigen-positive livers into hepatitis B virus-positive recipients and the role of hepatitis delta coinfection.

The scarcity of liver donors requires consideration of grafts from sources not previously used. Allografts from hepatitis B surface antigen (HBsAg)-carriers without a significant liver disease have been proposed for liver transplant recipients with hepatitis B virus (HBV)-related cirrhosis and hepatocellular carcinoma (HCC). Combination prophylaxis schemes against HBV post-liver transplantation (LT) recurrence are currently available; the efficacy of those schemes in HBV-related cirrhosis and HCC must be assessed. This report describes the allocation of HBsAg-positive grafts in three HBsAg-positive recipients, with HBV-related cirrhosis and evolving HCC lesions, two of them with hepatitis Delta virus (HDV) coinfection. Patients were administered anti-hepatitis B immunoglobulins (HBIGs) and lamivudine in order to prevent HBV recurrence. In spite of anti-HBV prophylaxis, HBV infection did persist after LT in all patients (no serum clearance of HBsAg). HBV replication assessed by serum HBV deoxyribonucleic acid (DNA) presence was detected in the first month after LT in the 3 recipients. A prompt HDV reinfection with a clinical and histological pattern of hepatitis was observed in the 2 HBV / HDV coinfected recipients. In 1 of them, an evolving chronic hepatitis required a second LT. The non-HDV-infected patient showed an uneventful follow-up, but the lack of the neutralizing effect of HBIGs and the high risk of escape mutants forced the addition of adefovir-dipivoxil to lamivudine, in order to prevent viral variants and hepatitis recurrence. In conclusion, allografts from HBsAg-positive donors in HBsAg-positive recipients are associated with the persistence of the HBsAg after LT due to the failure of HBIG prophylaxis, even if lamivudine does inhibit virion production. This condition favors HDV replication and HDV hepatitis recurrence in coinfected patients. The allocation of HBsAg-positive grafts in HBsAg-positive recipients could be justified only in recipients without HDV coinfection and a combined prophylaxis with lamivudine and adefovir-dipivoxil is currently the best way to manage escape mutants in these recipients.     

New era of liver transplantation for hepatitis B: a 17-year single-center experience

OBJECTIVE: To evaluate the variables affecting orthotopic liver transplantation (OLT) outcome for hepatitis B virus (HBV) in a large patient cohort over a 17-year period. SUMMARY BACKGROUND DATA: Historically, OLT for chronic HBV infection has been associated with aggressive reinfection and poor survival results. More recently, OLT outcome has been improved with the routine use of antiviral therapy with either hepatitis B immune globulin (HBIg) or lamivudine; however, HBV recurrence remains common. The authors studied the factors affecting HBV recurrence and outcome of transplantation, including the effects of combination viral prophylaxis with HBIg and lamivudine. METHODS: A retrospective review of 166 OLT recipients for chronic HBV over a 17-year period at a single center was performed. Median follow-up was 29 months. HBV recurrence was defined by HBsAg seropositivity after OLT. HBIg monotherapy was used in 28 (17%) patients, lamivudine monotherapy in 20 (12%), and HBIg and lamivudine combination in 89 (54%); 29 (17%) did not receive any HBV prophylaxis. Hepatocellular carcinoma (HCC) was present in 43 patients (26%) and urgent United Network for Organ Sharing (UNOS) status was assigned to 27 patients (16%). Univariate and multivariate analyses were performed to identify factors that affected OLT outcome. RESULTS: Overall 1-, 3-, and 5-year patient survival rates were 85.8%, 73.6%, and 71.8%, respectively. As expected, HBV recurrence-free survival rates were significantly lower than overall survival rates (76.4%, 58.7%, and 48.3%). When compared with a nontreated cohort, OLT recipients receiving combination viral prophylaxis with HBIg and lamivudine showed markedly reduced HBV recurrence rates and significantly improved 1- and 3-year recurrence-free survival rates. By univariate estimates, patient survival was reduced in the presence of HCC, in the Asian population, and urgent candidates by UNOS classification. Graft loss rates were significantly increased in urgent OLT candidates, Asians, patients with pretransplant positive DNA, and in the presence of HCC. Factors that were significant by univariate analysis or thought to be clinically relevant were subjected to multivariate analysis. By multivariate estimates, urgent UNOS or presence of HCC adversely affected patient and graft survival rates, whereas combination prophylactic therapy strongly predicted improved patient and graft survival rates as well as recurrence-free survival rates. CONCLUSIONS: Orthotopic liver transplantation for HBV under combination viral prophylaxis results in survival rates equivalent to other indications. Pretransplant viral replication, UNOS status, and the presence of HCC are all sensitive markers for posttransplantation outcome. Viral prophylactic therapy has effectively reduced HBV recurrence and prolonged survival outcomes. The combination of HBIg and lamivudine is the prophylactic regimen of choice.     

An Efficacy and Cost-Effectiveness Analysis of Combination Hepatitis B Immune Globulin and Lamivudine to Prevent Recurrent Hepatitis B After Orthotopic Liver Transplantation Compared With Hepatitis B Immune Globulin Monotherapy

Orthotopic liver transplantation (OLT) for hepatitis B virus (HBV) infection was limited until recently by poor graft and patient outcomes caused by recurrent HBV. Long-term immunoprophylaxis with hepatitis B immune globulin (HBIG) dramatically improved post-OLT survival, but recurrent HBV still occurred in up to 36% of the recipients. More recently, combination HBIG and lamivudine has been shown to effectively prevent HBV recurrence in patients post-OLT. The aim of the current study is to determine long-term outcome and cost-effectiveness of using combination HBIG and lamivudine compared with HBIG monotherapy in patients who undergo OLT for HBV. A retrospective chart review identified 59 patients administered combination HBIG and lamivudine and 12 patients administered HBIG monotherapy as primary prophylaxis against recurrent HBV. Lamivudine, 150 mg/d, was administered orally indefinitely. HBIG was administered under a standard protocol (10,000 IU intravenously during the anhepatic phase, then 10,000 IU/d intravenously for 7 days, then 10,000 IU intravenously monthly) indefinitely. A decision-analysis model was developed to evaluate the potential economic impact of prophylaxis against HBV with combination therapy compared with monotherapy. Recurrent HBV was defined as the reappearance of hepatitis B surface antigen (HBsAg) after its initial disappearance post-OLT. In the combination-therapy group, no patient redeveloped serum HBsAg or HBV DNA during mean follow-ups of 459 and 416 days, respectively. In the monotherapy group, 3 patients (25%) had reappearance of HBsAg in serum during a mean follow-up of 663 days. Combination therapy resulted in a dominant, cost-effective strategy with an average cost-effectiveness ratio of $252,111/recurrence prevented compared with $362,570/recurrence prevented in the monotherapy strategy. Combination prophylaxis with HBIG and lamivudine is highly effective in preventing recurrent HBV, may protect against the emergence of resistant mutants, and is significantly more cost-effective than HBIG monotherapy with its associated rate of recurrent HBV. (Liver Transpl 2000;6:741-748.)     

拉米夫定对肝移植术后乙肝病毒再感染的预防作用

目的 探讨单一应用拉米夫定预防良性乙肝相关性肝病肝移植术后乙肝病毒再感染的疗效。方法 总结单一应用拉米夫定预防肝移植术后生存时间大于3个月的31例良性乙肝相关性终末期肝病患者的乙肝病毒再感染情况，同时检测肝移植手术前、后血清及肝穿刺组织乙肝表面标志物及HBVDNA的变化。结果 31例患者随访时间平均为38．2个月（3．2～70．2个月），随访期间死亡8例。乙肝病毒总的再感染率为19．4％（6／31），术后1、3、5年乙肝再感染率分别为7．1％（2／28）、16．0％（4／25）及26．1％（6／23），生存率分别为87．1％（27／31）、80．6％（25／31）及66．1％（20．5／31）。术前HBeAg和HBVDNA的清除率分别为54．5％（6／11）和50．0％（5／10）。术前HBVDNA和HBeAg阳性患者术后乙肝病毒再感染率高。结论 拉米夫定可以有效地预防良性乙肝相关性肝病患者肝移植术后乙肝病毒的再感染；术前应尽可能使HBVDNA和HBeAg转阴。     

原位肝移植术后乙型肝炎病毒再感染的预防(附68例报告)

目的探讨原位肝移植术后乙型肝炎病毒(HBV)再感染的预防。方法68例病人分别为慢性乙型重型肝炎、终末期肝硬化和肝硬化合并肝癌病人,移植前后给予抗病毒药物预防HBV再感染,拉米夫定2例,拉米夫定加乙型肝炎免疫球蛋白(HBIG)63例,阿德夫韦加HBIG3例;观察预防性治疗后的临床表现、血清HBV、HBVDNA及肝活检免疫组织化学法检测等指标。结果应用拉米夫定的2例病人,有1例发生再感染,其血清HBsAg、抗Hbe、抗HBc和HBVDNA均呈阳性,肝活检免疫组织化学检测有HBsAg表达。用拉米夫定加HBIG预防的63例中,有2例再感染,血清均呈HBsAg、抗HBe和抗HBc阳性,肝活检免疫组织化学法检测有HBsAg表达,其中1例血清HBVDNA阳性。用阿德夫韦加HBIG预防的3例中,血清学和肝活检免疫组织化学法检测均无HBsAg表达。结论原位肝移植术是治疗HBV感染相关的终末期肝病的有效手段,拉米夫定加HBIG或阿德夫韦加HBIG联合应用可以有效地预防HBV的再感染。     

High Viremia,Prolonged Lamivudine Therapy and Recurrent Hepatocellular Carcinoma Predict Posttransplant Hepatitis B Recurrence†

Hepatitis B virus (HBV) recurrence following orthotopic liver transplantation (OLT) is generally preventable by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM). However, HBV recurrence sometimes develops despite prophylaxis. This study assessed posttransplant outcomes and identified predictors of HBV recurrence. We analyzed the outcomes of 209 consecutive patients positive for hepatitis B surface antigen who underwent OLT, who received either combination prophylaxis with HBIG and LAM (89.0%) or HBIG monoprophylaxis (11.0%). The median follow‐up was 36.8 months (range, 1.0–84.4). Posttransplant HBV recurrence occurred in 22 patients (10.5%), including 13 patients with drug‐resistant mutations. HBV recurrence was observed in six patients after hepatocellular carcinoma (HCC) recurrence. Independent predictors of HBV recurrence were recurrent HCC (p < 0.001), LAM therapy >1.5 years (p = 0.001) and high HBV DNA titers (≥10⁵ copies/mL) at OLT (p = 0.036). In conclusion, high viremia at OLT and prolonged exposure to LAM should be further stressed as main predictors of HBV recurrence.     

Clinical outcomes of liver transplantation for HBV-related hepatocellular carcinoma: data from the NIH HBV OLT study

Han SH, Reddy KR, Keeffe EB, Soldevila‐Pico C, Gish R, Chung RT, Degertekin B, Lok ASF. Clinical outcomes of liver transplantation for HBV‐related hepatocellular carcinoma: data from the NIH HBV‐OLT study.
Clin Transplant 2011: 25: E152–E162. © 2010 John Wiley & Sons A/S. Abstract: Background: Hepatitis B virus (HBV)‐related hepatocellular carcinoma (HCC) is an indication for orthotopic liver transplantation (OLT) in patients with tumor stage within the United Network for Organ Sharing criteria. The number of patients listed for HBV‐related HCC is increasing, while the number of patients listed for HBV‐related cirrhosis is declining presumptively because of the availability of more effective oral nucleos(t)ide analogues. This study presents the final, long‐term outcome of patients transplanted for HBV‐related HCC in the National Institutes of Health (NIH) HBV OLT Study Group. Results: Ninety‐eight patients (52.4%) in the NIH HBV OLT cohort underwent OLT for HBV‐related HCC. With a mean follow‐up of 36.5 months post‐OLT, 12 (12.2%) patients developed recurrence of HCC. Multivariate analysis did not find a statistically significant role of gender, tumor stage at OLT, pre‐OLT HCC treatment, recurrence of HBV, or duration of HCC diagnosis pre‐OLT in predicting HCC recurrence. Serum alpha‐fetoprotein (AFP) level >200 ng/mL at transplant was found to be statistically significant in predicting HCC recurrence (p = 0.003). HCC recurrence was significantly associated with decreased post‐OLT survival. Conclusion: HCC is the most common indication for OLT in patients with chronic hepatitis B in the era of more effective oral antivirals. Serum AFP at the time of OLT is significantly associated with HCC recurrence.