PREOPERATIVE SERUM LEVELS OF WILD-TYPE AND HEPATITIS-B E-ANTIGEN-NEGATIVE HEPATITIS-B VIRUS (HBV) AND GRAFT INFECTION AFTER LIVER-TRANSPLANTATION FOR HBV-RELATED HEPATOCELLULAR-CARCINOMA

Allograft infection in hepatitis B surface antigen (HBsAg)-positive pa tients undergoing liver transplant (OLT) is still significant, despite post-transplant prophylaxis with high doses of immunoglobulin to HBsA g, Baseline status and post-OLT levels of viraemia and wild-type and h epatitis B e antigen (HBeAg)-negative hepatitis B virus (HBV) were cor related with the clinical course of 16 consecutive HBsAg carriers, pos itive for hepatitis B e antibody, with hepatocellular carcinoma who un derwent OLT and received permanent post-OLT prophylaxis with antibody to HBsAg (HbsAb). Fourteen patients had less than 10(3) HBV genome equ ivalents ml(-1) (eqml(-1)) at baseline and remained HBV free after a m edian of 36 months following OLT, Two patients with mean pre-OLT virae mia higher than 10(5) genome eqml(-1) and prevalent HBeAg-negative HBV viraemia before OLT suffered a severe graft hepatitis, Interferon-alp ha 2b (3 MU m(-2) per day) was able to reduce viraemia in both patient s and to revert the clinical course of the infection in one, who remai ned infection-free 22 months after IFN treatment. Fourteen patients ha d less than 10(3) HBV genome eq ml(-1) at baseline and remained HBV fr ee, after a median of 36 months following OLT, with permanent HBsAb im munoprophylaxis. These observations suggest that the quantitative anal ysis of HBV pre-OLT viraemia levels may provide a very useful tool for predicting the ideal time of liver replacement. Clinical trials on th e use of antiviral drugs capable of inhibiting HBV serum levels before liner transplantation should be pursued on this premise.