DE-NOVO HEPATITIS-B INFECTION AFTER LIVER-TRANSPLANTATION - SOURCE OFDISEASE, INCIDENCE, AND IMPACT

New-onset hepatitis B (de novo B) after liver transplantation (OLTX) i s an emerging concern. The goals of our study were to determine the in cidence and pattern of this infection, to attempt determination of ris k factors and the role of immunosuppression, and to review its morbidi ty/ mortality. Over a 10-year period, 1078 OLTX were performed in 956 patients at our institution. Eight hundred twenty-six patients had pro ven negative hepatitis B surface antigen (HBsAg) before transplantatio n. Among these, 14 patients (1.7%), 8 women and 6 men, ages 21-59 year s (median, 42 years), developed positive HBsAg after transplantation a nd were defined as de novo B. In 10 of 14 patients (71%), positive HBs Ag was revealed during routine annual visits, whereas 4 patients had t iter verification prompted by illness. Blood product use (cryoprecipit ate, fresh-frozen plasma, platelets, and packed red blood cells) durin g the transplant hospitalization was similar between groups. Pretransp lant hepatitis C infection was more prevalent among the 14 patients wi th denovo B (7 of 14, 50% v129 of 812, 16%; P less than or equal to .0 5). Hepatitis B vaccine had been given to 12 patients (86%) (but not g iven to 2) who developed de novo B. Incidence and severity of rejectio n were similar in both populations, although de novo B patients had mo re late rejections. Our use of immunosuppressive protocols was the sam e in both groups. Mean follow-up of the infected patients is 24 (5-51) months. Twelve of these 14 de novo B patients were not clinically ill , with normal or near-normal transaminase levels. One of 14 has died f rom complications related to hepatic artery revascularization, and ano ther is well after repeat OLTX for biliary strictures. Half of these d e novo B patients remain free from viral antigens in their transplante d liver tissue. The high percentage of positive hepatitis C patients w ho acquire de novo B may indicate a link between these two viral infec tions and potential risk factor for de novo B. The origins of this inf ection are most likely multifactorial, needing further study. De novo B after liver transplantation is preliminarily associated with little clinical morbidity and mortality. Copyright (C) 1998 by the American A ssociation for the Study of Liver Diseases.