PRECORE AND CONTIGUOUS REGIONS OF HEPATITIS-B VIRUS IN LIVER-TRANSPLANTATION FOR END-STAGE HEPATITIS-B

Background/Aims: Recurrent hepatitis B virus (HBV) infection is the le ading cause of mortality and morbidity after orthotopic liver transpla ntation (OLT) for HBV-related liver disease, but the extent of viral g enetic variation in this setting remains unknown. Methods: Eight patie nts who underwent OLT for HBV-related liver disease were studied; 7 ha d cirrhosis and 1 had fulminant hepatitis. Four patients received long -term hepatitis B immunoglobulin prophylaxis. A 240-base pair fragment (1742-1981) comprising the precore region of HBV was amplified by pol ymerase chain reaction from sera drawn before OLT and 6, 12, and 24 mo nths after OLT and analyzed. Results: All sera were positive by polyme rase chain reaction. Nucleotide sequence variations were congruent wit hin most patients before and after OLT; however, in one patient, subst antial sequence variation was observed, suggesting infection with a ne w HBV strain. No sequence variation associated with a particular outco me could be identified. Two patients harbored HBV variants with a dele tion or insertion upstream of the precore messenger RNA initiation sit e. Conclusions: Reinfection after OLT can occasionally be caused by HB V strains different from the one present before OLT. Changes within th e sequenced region are not predictive of the outcome of reinfection.