Four-year follow-up of two chronic hepatitis B recipients of hepatitis B surface antigen-positive cadaveric liver grafts from asymptomatic carriers

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http://onlinelibrary.wiley.com/doi/10.1111/j.1872-034X.2011.00840.x/abstract

Four-year follow-up of two chronic hepatitis B recipients of hepatitis B surface

antigen-positive cadaveric liver grafts from asymptomatic carriers

Zuoyi Jiao1, Youcheng Zhang1, Lin Han2, Yong Zeng3, Lunan Yan3,*Article first

published online: 26 AUG 2011

DOI: 10.1111/j.1872-034X.2011.00840.x

© 2011 The Japan Society of Hepatology

Issue

Hepatology Research

Volume 41, Issue 9, pages 846–852, September 2011

Aim:  Only seven cases of liver transplantation (OLT) with positive serum

hepatitis B surface antigen (HBsAg) grafts have been reported in the world till

now. Here we report the 4-year follow-up results and clinical pathologic

characteristics of two recipients of chronic hepatitis B transplanted with

HBsAg-positive cadaveric liver grafts from asymptomatic carriers.

Methods:  Lamivudine combined with hepatitis B immune globulin were used for

the control of hepatitis B virus (HBV) infection in both of the recipients

post-OLT. The liver functions, virus status and pathologic characteristics of

two recipients were followed up according to the rounte protocol of Liver

Transplantation Center of West China Hospital.

Results:  The serum HBV deoxyribonucleic acid (DNA) turned negative within 30

days post-OLT, but HBsAg remained positive for both of the recipients during

follow up. HBV breakthrough occurred in one recipient at the month 12 post-OLT,

with detectable serum HBV-DNA (740 copies/mL) and

tyrosine-methionine-aspartate-aspartate motif mutation (rtM204I and rtM204V).

After the replacement of lamivudine by adefovir dipivoxil 10 mg daily for 2

months, serum HBV-DNA of this recipient became undetectable again and maintained

undetectable during follow up. Both of the recipients have survived for more

than 4 years post-OLT, with stable liver function and mild hepatitis.

Conclusion:  Due to extreme scarcity of liver graft, we think that

HBsAg-positive liver graft without active HBV-DNA replication and severe

pathological manifestation from asymptomatic carriers may deserve consideration

when no other graft is available in a bearable waiting time.