S. Kubo et al., Reactivation of viral replication after liver resection in patients infected with hepatitis B virus, ANN SURG, 233(1), 2001, pp. 139-145
Objective
To investigate the mechanisms and risk factors underlying postoperative rea
ctivation of hepatitis after liver resection for hepatitis B virus-related
hepatocellular carcinoma.
Summary Background Data
Although risk factors for acute hepatic failure after liver resection have
been reported in patients with chronic liver disease, the issue of reactiva
tion of hepatitis B virus replication after liver resection is unresolved.
Methods
Fifty-five patients with hepatocellular carcinoma and hepatitis B surface a
ntigen underwent liver resection. in 25 of these 55 patients, serum levels
of hepatitis B virus DNA and the type of hepatitis B virus were determined
before and after surgery.
Results
Postoperative hepatitis occurred in 13 of the 55 patients (24%). Reactivati
on of viral replication occurred after liver resection in 7 of the 25 patie
nts tested, and alanine aminotransferase activity increased in 6 of these 7
patients. High preoperative alanine aminotransferase activity, high levels
of hepatitis B virus DNA, presence of wild-type DNA, and detection of hepa
titis B core antigen in hepatocytes, all features of the immune clearance p
hase in the natural course of hepatitis B virus infection with no surgery,
were more likely to be found in patients with reactivation than in patients
without reactivation.
Conclusions
During the immune clearance phase of hepatitis B virus infection, especiall
y the period of acute exacerbation, changes in serum hepatitis B virus DNA
level should be monitored for early warnings of reactivation of viral repli
cation, likely to cause severe postoperative hepatitis and acute hepatic fa
ilure.