VARIABILITY OF THE HEPATITIS-B SURFACE PROTEIN IN HBV-INFECTED LIVER-TRANSPLANT RECIPIENTS

Variations in the major surface proteins (HBsAg) of hepatitis B virus (HBV) have been implicated in the high rate of reinfection in HBV-infe cted recipients of orthotopic liver transplantations (OLT), Sera from 6 OLT patients positive for HBsAg and from 3 recipients negative for i t prior to transplantation were analyzed over several years, and 39 HB sAg sequences were compared. Despite anti-HBs immunoprophylaxis result ing in the disappearance of HBsAg, HBV DNA was detectable by a sensiti ve nested PCR in almost all sera, In 1 patient, a significant temporar y shift in HBV subtypes was observed, indicating a mixed infection or the presence of multiple HBV populations in this patient; this was als o true for other patients. Amino acid substitutions compared to wild-t ype HBV subtypes in 7 patients and variations within patients in 5 pat ients were detectable over time; the 'escape mutation' at amino acid p osition 145 was detected in 2 patients, Our data suggest that the high rate of reinfection in OLT recipients seems not to be associated with specific sequence variations in the major HBs gene, but shows a remar kable inter-and intraindividual variability, Obviously, no correlation between heterogeneity in this gene and clinical outcome was present.