RECURRENT HEPATITIS-B IN LIVER ALLOGRAFTS - A DISTINCTIVE FORM OF RAPIDLY DEVELOPING CIRRHOSIS

Recurrent hepatitis B virus (HBV) infection in the liver allograft is a significant cause of morbidity and mortality in those transplanted f or chronic HBV disease. A detailed histological and immunohistochemica l study of recurrent HBV disease in liver allografts was carried out u sing archival paraffin-embedded tissue. A total of 34 follow-up liver biopsies from 14 patients transplanted for HBV were available for stud y. In addition to routine stains, sections were stained with antibodie s to a range of HBV antigens. Two patients transplanted for acute HBV remained free of re-infection. Five of seven patients transplanted for chronic HBV disease who were followed-up, developed HBV-associated ci rrhosis 12-23 months later. Hepatocyte ballooning, high nucleocapsid a ntigen load, ductular proliferation and immature fibrous tissue charac terized this unusual cirrhosis, which developed rapidly from fibrosing cholestatic hepatitis in at least three cases. Death from liver failu re supervened quickly in three of the five patients. These findings su pport the concept that HBV infection in the liver allograft can be a d ifferent disease from that occurring in the non-transplant setting, an d may be related to high antigen load.