PRETRANSPLANTATION INTERFERON TREATMENT AND RECURRENCE OF HEPATITIS-BVIRUS-INFECTION AFTER LIVER-TRANSPLANTATION FOR HEPATITIS-B RELATED END-STAGE LIVER-DISEASE

Orthotopic liver transplantation in patients with hepatitis B-related cirrhosis is commonly complicated by reinfection with the hepatitis B virus, with rapidly progressive liver disease and poor survival rate. We assessed the efficacy of prior therapy with recombinant interferon- alpha on the prevention of posttransplantation hepatitis B virus reinf ection. Twenty-two patients with hepatitis B-related cirrhosis waiting for liver transplantation received 3 MU (decreased to 1.5 MU in cases of intolerance) of recombinant interferon-alpha until transplantation . The rates of posttransplantation hepatitis B virus reinfection and s urvival in this group were compared with those in a group of 26 patien ts previously given transplants for the same disease but not given int erferon therapy. The same protocol of HBs antibody passive immunoproph ylaxis was applied after transplantation in both groups. Recombinant i nterferon-alpha was administered for 14 +/- 7 wk. The treatment had an antiviral effect, with disappearance of serum hepatitis B virus DNA i n seven of the eight patients initially positive for hepatitis B virus DNA and disappearance of HBeAg in two of the three patients initially positive for HBeAg. Serum hepatitis B virus DNA remained detectable w ith polymerase chain reaction at transplantation in 56% of the interfe ron-treated patients. After transplantation, hepatitis B virus reinfec tion was more frequent in polymerase chain reaction-positive than in p olymerase chain reaction-negative patients (78% vs. 17%, p < 0.05). On e patient's condition deteriorated during interferon treatment; this p atient was not given a transplant. Two patients (in whom hepatitis B v irus DNA disappeared from serum) improved so markedly during treatment that they were not given transplants. The rates of posttransplant hep atitis B virus reinfection (44% and 58%, respectively), the delay of h epatitis B virus reinfection (8 +/- 5 mo and 6 +/- 3 mo, respectively) and the survival rates (83% and 69%, respectively) were not statistic ally different in the interferon-treated and untreated groups. We conc lude that, in patients with hepatitis B-related cirrhosis, pretranspla ntation recombinant interferon-alpha, at the dosage and duration we us ed, has an antiviral effect but does not prevent posttransplantation h epatitis B virus reinfection. Detection of serum hepatitis B virus DNA with polymerase chain reaction before transplantation might be useful in predicting reinfection after transplantation.