Viral Persistence After Liver Transplantation for Hepatitis B Virus: A Cross-Sectional Study

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Viral Persistence After Liver Transplantation for Hepatitis B Virus: A

Cross-Sectional Study.

Original Articles

Transplantation. 85(8):1105-1111, April 27, 2008.

Freshwater, Dennis A. 1,2; Dudley, Tracey 1; Cane, 2,3; Mutimer,

J. 1,2,4

Abstract:

Background. Prophylaxis to prevent recurrent HBV infection in liver transplant

(LT) recipients has evolved over time, and we manage patients who receive

lamivudine monoprophylaxis, lamivudine with HBV immunoglobulin (HBIg), and

lamivudine and adefovir with HBIg.

Methods. Serum was examined with sensitive assays to detect the persistence of

HBV, and to identify mutations that might confer resistance to the antiviral

prophylaxis. Forty patients were studied, and sera were collected 20 days to

13.3 years after LT.

Results. Overall, HBV DNA was detected in serum of 67.5% of patients (8 of 10 of

lamivudine monoprophylaxis patients, 15 of 24 of those receiving lamivudine and

HBIg, and 4 of 6 of those receiving lamivudine, adefovir and HBIg). Thus, HBV

infection persists for most of the patients despite successful prophylaxis after

LT. Of those patients with detectable serum HBV DNA, three of eight of the

lamivudine monoprophylaxis group had sequences associated with resistance to

lamivudine (YMDD mutants), compared with only 1 of 15 of the lamivudine and HBIg

cohort. Three of the lamivudine and HBIg cohort had the I126A Hepatitis B

surface antigen escape variant. In those serum HBV DNA-positive patients who

were receiving lamivudine, adefovir, and HBIg, only one of four had YMDD mutant,

and none had Hepatitis B surface antigen escape variants. None of the 40

patients suffered clinical HBV recurrence.

Conclusions. Our observations imply that the selection of resistant virus may be

essential, but is not sufficient to cause overt failure of prophylaxis with

development of clinical disease. It seems likely that the patients' immune

response contributes, at least partially, to the long-term control of infection

in these patients.

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