Serum hepatitis B virus DNA before liver transplantation correlates with HBV reinfection rate even under successful low-dose hepatitis B immunoglobulin prophylaxis

March 31, 2011

http://www.springerlink.com/content/h1612r3r3159r472/

Medicine

Hepatology International

DOI: 10.1007/s12072-011-9265-zOnline First™Open Access

Original Article

Serum hepatitis B virus DNA before liver transplantation correlates with HBV

reinfection rate even under successful low-dose hepatitis B immunoglobulin

prophylaxis

Tetsuya Yasunaka, Akinobu Takaki, Takahito Yagi, Yoshiaki Iwasaki, Hiroshi

Sadamori, Kazuko Koike, Satoshi Hirohata, Masashi Tatsukawa, Daisuke Kawai and

Hidenori Shiraha, et al.

Abstract

Purpose

The combination of hepatitis B immunoglobulin (HBIg) and nucleos(t)ide analogues

has been accepted as the best treatment to control hepatitis B recurrence after

orthotopic liver transplantation (OLT). However, the optimal dose of HBIg

remains unclear. We have previously reported that high-dose HBIg in the early

period followed by low-dose HBIg with nucleos(t)ide analogues offers reliable

and cost-effective control of hepatitis B recurrence. The aim of this study was

to investigate intrahepatic hepatitis B virus (HBV) reinfection status with our

clinically successful protocol.

Methods

We quantified levels of intrahepatic HBV covalently closed circular (ccc)

deoxyribonucleic acid (DNA) and serum hepatitis B core-related antigen (HBcrAg),

a new serological marker that can estimate intrahepatic cccDNA levels.

Nucleos(t)ide analogues were administered in all cases.

Results

No patients showed recurrence of hepatitis B surface antigen (HBsAg) or HBV-DNA.

However, HBV, cccDNA, and HBcrAg were positive in 57% and 48% of patients after

OLT, respectively. Pre-OLT serum HBV-DNA and HBcrAg levels correlated linearly

with post-OLT cccDNA levels (r = 0.534, P < 0.05, and r = 0.634, P < 0.05,

respectively). High serum HBV-DNA and HBcrAg levels, particularly with >3 log10

copies/mL and >4 log10 IU/mL, respectively, at the time of OLT, were associated

with high levels of post-OLT cccDNA. Even with our successful protocol, nearly

half of patients showed HBV reinfection.

Conclusions

Patients with high serum HBV-DNA and HBcrAg levels before OLT (particularly >3

log10 copies/mL and >4 log10 IU/mL, respectively) should be followed with care

for HBV recurrence.

March 31, 2011