Perioperative reactivation of hepatitis B virus replication in patients undergoing partial hepatectomy for hepatocellular carcinoma

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http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06888.x/abstract

Perioperative reactivation of hepatitis B virus replication in patients

undergoing partial hepatectomy for hepatocellular carcinoma

Liang Huang1,†, Jing Li1,†, Wan Yee Lau1,2, Jianjun Yan1, uo Zhou1, Caifeng

Liu1, Xianghua Zhang1, Jun Shen1, Mengchao Wu1, Yiqun Yan1,*DOI:

10.1111/j.1440-1746.2011.06888.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

ABSTRACT

Background. Reactivation of hepatitis B virus (HBV) replication happens in

patients who receive transarterial chemoembolization or systemic chemotherapy

for hepatocellular carcinoma (HCC). The incidence and risk factors of HBV

reactivation during the perioperative period in HCC patients receiving hepatic

resection is unknown.

Methods. Between May 2009 and November 2010, 164 consecutive patients with

HBV-related HCC who underwent hepatic resection were prospectively enrolled in

the study. Among these, 126 patients received antiviral treatment before the

operation (the antiviral group) and 38 patients did not receive any antiviral

treatment (the non-antiviral group).

Results. Ten patients (6.1%) developed HBV reactivation perioperatively (within

one month after hepatectomy). The incidence of HBV reactivation in the antiviral

group and non-antiviral group were 1.6% (2/126) and 21.1% (8/38), respectively

(P < 0.001). On univariate analysis, preoperative HBV DNA < 1.0 × 103 copies/ml

and non-antiviral therapy were significantly correlated with the occurrence of

HBV reactivation (P = 0.044 and P < 0.001, respectively). Only non-antiviral

therapy remained as a predictive factor on multivariate analysis (OR, 15.46; 95%

CI, 2.80-85.46, P = 0.002). The recovery of liver function (defined as a

decrease of alanine aminotransferase back to normal) was achieved in 86.8%

(132/152) patients without HBV reactivation and in 37.5% (3/8) patients with HBV

reactivation when evaluated on day 30 after hepatectomy (P < 0.001).

Conclusion. Hepatectomy could reactivate HBV replication during the

perioperative period, especially in patients who did not receive any antiviral

therapy. A close monitoring of HBV DNA during the perioperative period was

necessary irrespective of the preoperative HBV DNA level. Once HBV was

reactivated, antiviral therapy should be given.