Hepatitis B virus (HBV) genotypes have been associated with specific patterns of disease and response to antiviral therapy. We investigated the effect of HBV genotype on HBV recurrence and mortality after liver transplantation (LT). Pretransplant sera of 45 hepatitis B surface antigen (HBsAg) positive adults were submitted for HBV genotyping by a reverse-phase hybridization line probe assay with genotype-specific probes. Data were correlated with clinical outcomes after transplantation. Genotype A (n β«,)51Ψβ¬ D (n β«Ψβ¬ 13) and A/D (n β«Ψβ¬ 12) accounted for 89% of all genotypes. Coinfection with two HBV genotypes was encountered in 14 (31.1%) patients. Eighteen patients (40 %) developed HBV recurrence at a median of 10 months posttransplant (range, 1-53) and 10 patients (22 %) died at a median of 24 months (range, 3-63). Genotype D patients were more likely to develop HBV recurrence or die compared with genotype A patients, although this did not reach statistical significance. Dual infection with genotype A/D resulted in mortality similar to that of genotype A but recurrence similar to that of genotype D. Active viral replication at time of transplantation was the only independent factor (P β«Ψβ¬ 0.03) that predicted HBV recurrence. In conclusion, HBV genotype A and D did not have a significant impact on clinical outcomes of LT for HBV-related liver disease in patients of European origin. These data do not support routine HBV genotyping in liver transplantation. (Liver Transpl 2004;10:58 -64.)
HBV is classified into seven genotypes (A-G) based on comparison of complete HBV genomes. [1][2][3][4] Geographic variations in genotype distribution have been documented, with genotypes A and D prevalent in Northern Europe, North America, and Central Africa, 5 while genotypes B and C are common in Southeast Asia, China, and Japan. 6 Genotype E is almost confined to Africa, genotype F to South America and Polynesia, and genotype G to the United States and France. 7 More recently, a new genotype (H), closely related to genotype F, has been identified in Central America. 8 Factors that influence the long-term outcome of chronic HBV infection include host-related factors such as age at infection, sex, and immune competence; environmental factors including alcohol excess; and coinfection with other viruses. 9 More recently, the relationship between HBV genotypes and specific patterns of HBVinduced disease and response to treatment has been explored. 6,10 -14 Genotype C has been associated with more severe chronic liver disease compared with genotype B in Asia, and with lower response rates to interferon therapy in Taiwan. 15 Genotype B has been associated with a significantly lower prevalence of hepatitis B e antigen (HBeAg) positivity at presentation and a higher rate of spontaneous seroconversion in Chinese and Japanese patients, 11,16 while genotype C predominates in chronic hepatitis B surface antigen (HBsAg) carriers who develop HCC in Japan. 17 In Europe, genotypes A and D are common in patients with chronic hepatitis 5,13 with higher rates of biochemical remission and HBsAg clearance reported in genotype A patients compared with genotype D patients. 13 Thus, the long-term outcome of chronic HBV infection may be different in patients infected with different HBV genotypes.
Liver transplantation (LT) is an established treatment for patients with end-stage liver disease and acute liver failure secondary to HBV infection. However, reinfection of the graft is very common in the absence of prophylaxis 18 and is the main cause of morbidity and mortality after LT for HBV-related disease. 19 Longterm passive immunoprophylaxis with hepatitis B