Evidence of serious graft damage induced by de novo hepatitis B virus infection after liver transplantation

De novo hepatitis B virus (HBV) infection after orthotopic liver transplant ation (OLT) is commonly believed to be a relatively benign condition, in co ntrast to post-OLT infection recurrence, considered a very aggressive compl ication. We reviewed the charts of 569 non-HBV-related OLTs performed at ou r institution and identified 19 patients (3%) with de novo HBV infection (a ppearance of hepatitis B surface antigen [HBsAg] after OLT). After a median follow-up of 25 months beyond the detection of HBsAg, 12 patients (63%) ha d developed serious HBV-related graft damage (cirrhosis in 6 patients, brid ging chronic hepatitis in 4 patients, and fulminant hepatitis in 2 patients ); 7 patients (37%) had lost their grafts; and 4 patients (21%) had died. A ll graft losses and deaths were related to de novo HBV infection. Similar r ates of severe graft damage (62%), graft loss (38%), and death (33%) relate d to HBV infection were found in a concomitant series of 21 patients with r ecurrent HBV infection after OLT. Responses to antiviral therapy (interfero n or lami-vudine) were also similar in the 2 groups of patients. In 12 pati ents with de novo HBV infection, evidence of past HBV infection (positive s erum antibody to hepatitis B core antigen and/or serum or liver tissue HBV DNA) were detected in the donor (7 patients) or recipient (5 patients). No differences were observed in the clinical course after stratification accor ding to the attributed origin of de novo HBV infection. We conclude that de novo HBV infection after OLT is associated with high rates of morbidity an d mortality, similar to those described for post-OLT HBV infection recurren ce.