Pw. Angus et al., HEPATITIS-B VIRUS PRECORE MUTANT INFECTION IS ASSOCIATED WITH SEVERE RECURRENT DISEASE AFTER LIVER-TRANSPLANTATION, Hepatology, 21(1), 1995, pp. 14-18
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.