HEPATITIS-B VIRUS PRECORE MUTANT INFECTION IS ASSOCIATED WITH SEVERE RECURRENT DISEASE AFTER LIVER-TRANSPLANTATION

The factors that predispose patients undergoing liver transplantation for hepatitis B virus (HBV) disease to severe recurrence of infection are unclear. In this study we examined the effect of pretransplantatio n infection with HBV and precore variant strains of HBV on posttranspl antation outcome and allograft histology in 24 patients who survived m ore than 3 months after liver transplantation. Based on pretransplanta tion serum HBV DNA status as detected by the polymerase chain reaction (PCR) and direct sequencing, the 24 patients could be assigned to thr ee groups. In group 1 there were 4 patients HBV DNA-negative before tr ansplantation and none of these patients suffered recurrence of infect ion posttransplantation. In group 2, of 10 patients with pretransplant ation infection with wild-type virus, 7 became reinfected, and 1 of th ese developed HBV-related graft failure, In group 3, 9 of 10 patients infected with precore mutant HBV strains became reinfected, However, i n contrast to the patients in group 2, 7 patients in group 3 developed HBV-related graft loss, and 5 of these patients had fibrosing cholest atic hepatitis (FCH). These results indicate that infection with preco re mutant strains of HBV predisposes a patient to early graft loss fol lowing transplantation.