Viral persistence after liver transplantation for hepatitis B virus: a cross-sectional study

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Transplantation. 2008 Apr 27;85(8):1105-11.

Viral persistence after liver transplantation for hepatitis B virus: a

cross-sectional study.

Freshwater DA, Dudley T, Cane P, Mutimer DJ.

1 The Liver and Hepatobiliary Unit, Queen Hospital, Edgbaston,

Birmingham, United Kingdom. 2 University of Birmingham, Edgbaston, Birmingham,

United Kingdom. 3 Health Protection Agency, Porton Down, Salisbury, United

Kingdom.

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.

PMID: 18431229 [PubMed - in process]

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