HEPATITIS-B VIRUS-INFECTION IN LIVER ALLOGRAFTS

Liver transplantation of hepatitis B surface antigen (HBsAg)-positive patients has been associated with high morbidity and mortality seconda ry to hepatitis B (HB) recurrence in the graft. Eight patients of the Queensland Liver Transplant Service were HBsAg positive pretransplant. Six acquired HB infection of the graft, one developed serological rec urrence of HB before early death from sepsis, and one HB e antigen-neg ative patient permanently cleared the virus. HB-infected grafts showed early expression of viral antigen, acute hepatitis, fibrosing cholest atic hepatitis, chronic active hepatitis, cirrhosis, or minimal change s associated with a carrier state. Only in the latter case was HB mild and nonprogressive. Cases of fibrosing cholestatic hepatitis progress ed rapidly to liver failure; they showed fibrosis and plates of ductul ar epithelium extending from portal tracts into lobules, cholestasis, ballooning of hepatocytes, and prominent hepatocyte expression of vira l antigens. Perioperative HB immunoglobulin proved ineffective in prev enting HB recurrence. One other patient became HBsAg positive for the first time after retransplantation; he developed severe acute hepatiti s, then chronic active hepatitis. Our biopsy findings support the view that, in liver allografts, the HB virus may be directly cytopathic.