A PRETRANSPLANT INFECTION WITH PRECORE MUTANTS OF HEPATITIS-B VIRUS DOES NOT INFLUENCE THE OUTCOME OF ORTHOTOPIC LIVER-TRANSPLANTATION IN PATIENTS ON HIGH-DOSE ANTI-HEPATITIS-B VIRUS SURFACE-ANTIGEN IMMUNOPROPHYLAXIS

Hepatitis B virus (HBV) infection of the liver graft is a major compli cation after orthotropic liver transplantation (OLT) for HBV-related c irrhosis. A high viral load before OLT is a known risk factor, whereas the relevance of precore mutants of HBV is a subject of controversy. The aim of this study was to correlate the pretransplantation viral lo ad and a pretransplantation infection with precore mutant HBV (pmHBV) or wildtype HBV (wtHBV) with allograft damage, graft failure, and surv ival after OLT. Sixty-nine patients with HBV cirrhosis underwent OLT u nder high dose immunoprophylaxis with anti-hepatitis B surface (HBs) t ype immunoglobulins (HBIg), A pretransplantation infection with pmHBV and wtHBV was detected by polymerase chain reaction (PCR) and direct s equencing in 30 patients each (pmHBV and wtHBV group), Nine of 69 pati ents were PCR-negative (noHBV group), Median pretransplantation levels of HBV DNA assessed by hybridization assay were 42 pg/mL for pmHBV an d 54 pg/mL for wtHBV patients. HDV recurred ill 17 of 30 (57%) of pmHB V and in 14 of 30 (47%) of wtHBV patients and graft failure occurred i n 6 of 30 (20%) of pmHBV and 7 of 30 (23%) of wtHBV patients. Neither HBV recurrence nor graft failure occurred in patients in whom no HBV D NA could be detected by PCR using primers flanking the HBV precore reg ion (noHBV) patients. Allograft damage assessed by histology activity index (HAI) scoring was median 6 for pmHBV and 7 for wtHBV patients, C umulative survival after 5 years was 72% for pmHBV, 74% for wtHBV, and 100% for noHBV patients, In this study, we protide evidence that pret ransplantation viral load, but not infection with pmHBV, determines th e outcome after OLT in patients on high. dose HBIg prophylaxis.