The factors that predispose patients undergoing liver transplantation for hepatitis B virus (HBW disease to severe recurrence of infection are unclear. In this study we examined the effect of pretransplantation infection with HBV and precore variant strains of HBV on posttransplantation outcome and allograft histology in 24 patients who survived more than 3 months after liver transplantation. Based on pretransplantation serum HBV DNA status as detected by the polymerase chain reaction (PCR) and direct sequencing, the 24 patients could be assigned to three groups. In group 1 there were 4 patients HBV DNA-negative before transplantation and none of these patients suffered recurrence of infection posttransplantation. In group 2, of 10 patients with pretransplantation infection with wild-type virus, 7 became reinfected, and 1 of these developed HBV-related graft failure. In group 3, 9 of 10 patients infected with precore mutant HBV strains became reiufected. However, in contrast to the patients in group 2,7 patients in group 3 developed HBV-related graft loss, and 5 of these patients had fibrosing cholestatic hepatitis (FCH). These resulta indicate that infection with precore mutant strains of HBV predisposes a patient to early graft loss following transplantation. (HEPATOLOGY 1995;21:14-18.)
The results of liver transplantation in patients with hepatitis B virus (HBV) infection have been disappointing, largely as a result of the high frequency of HBV disease recurrence in the transplanted liver.'-3 Recurrent HBV infection commonly results in progressive liver disease and, in some cases, leads to graft failure within just a few months of transplantation. Severe posttransplantation recurrence of HBV is associated with very high levels of viral replication and the accu-Abbreviations: FCH, fibrosing cholestatic hepatitis; HBcAg, hepatitis B core antigen; HBeAg, hepatitis B e antigen; HBIg, hepatitis B immunoglobulin; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HD, hepatitis delta; HDAg, hepatitis delta antigen; Ig, immunoglobulin; PCR, polymerase chain reaction.