Evolution of wild-type and precore mutant HBV infection after liver transplantation

Recurrence of hepatitis B virus (HBV) infection after liver transplantation is associated with varying degree of graft damage. The aim of the study wa s to investigate longitudinally the changes of wild-type and precore A(1896 )HBV mutant viral populations after reinfection and their impact on liver g raft damage. The wild-type HBV and A(1896)HBV strains were quantitated befo re and serially after orthotopic liver transplantation (OLT) in 14 hepatiti s B surface antigen (HBsAg)positive liver graft recipients (4 hepatitis B s urface antigen [HBeAg]+; 10 anti-HBe+). Before OLT, the wild-type precore H BV was present in all 4 HBeAg-positive patients and in 2/10 anti-HBe-positi ve patients; a mixed virus population was present in 6 patients; and A(1896 )HBV mutant alone in 2 patients. After OLT, A(1896)HBV mutant appeared and gradually accumulated in 5/6 patients who had the wild-type HBV before OLT and 1 of these patients seroconverted from HBeAg to anti-HBe 52 months afte r transplantation. A mixed HBV population was present continuously in 6 pat ients before and after OLT. Of the 2 patients with A(1896)HBV only pre-OLT, the wild type appeared in one patient and the other patient retained persi stently the A(1896)HBV mutant. There was no relationship between liver graf t histology and the type of viral population at reinfection or at the end o f follow up. Changes in the HBV population occur during follow up of recurr ent hepatitis B in liver transplant recipients with frequent accumulation o f precore A(1896)HBV mutants, but the type of viral population does not det ermine the severity of hepatitis B in the graft. (C) 1999 Wiley-Liss, Inc.