LIVER TRANSPLANTATION(2)

liver411

December 2003 . Volume 9 . Number 12

Original Articles

Subclinical reactivation of hepatitis B virus in liver transplant recipients
with past exposure

Manal F. Abdelmalek* [MEDLINE LOOKUP]
Tousif M. Pasha* [MEDLINE LOOKUP]
Nizar N. Zein? [MEDLINE LOOKUP]
David H. Persing? [MEDLINE LOOKUP]
Russell H. Wiesner? [MEDLINE LOOKUP]
David D. Douglas*§ [MEDLINE LOOKUP]  . Previous article in Issue
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   Abstract  TOP


Transmission of hepatitis B infection has been reported in liver transplant
recipients whose donor livers were negative for hepatitis B surface antigen
(HBsAg) and positive for antibody to hepatitis B core antigen (anti-HBc).
These infections usually have a mild clinical course and no adverse effects
on survival. However, the outcome of liver transplant recipients with
serologic evidence of past infection to hepatitis B virus (HBV) is unknown.
The prevalence of HBV DNA positivity by polymerase chain reaction (PCR)
pretransplantation in HBsAg-negative, anti-HBc-positive people is reported
to be 0% to 32%. To assess the prevalence of HBV DNA in pretransplantation
serum and liver tissue and to determine the clinical outcome of
HBsAg-negative, anti-HBc-positive recipients, we retrospectively reviewed
the first 693 orthotopic liver transplantations performed at Mayo Clinic
between March 19, 1985, and May 25, 1996. Pretransplantation specimens of
frozen serum and liver tissue were available for HBV DNA by PCR for 35 of 56
HBsAg-negative, anti-HBc-positive recipients. Twenty-two recipients had
positive serologic findings for anti-HBc alone, and 13 were positive for
anti-HBc and antibody to HBsAg (anti-HBs). Pretransplantation prevalence of
HBV DNA in HBsAg-negative, anti-HBc-positive recipients was 6% (serum) to
29% (liver). Of those recipients whose liver was HBV DNA-positive
pretransplantation, 40% also had evidence of HBV DNA in posttransplantation
liver biopsy specimens, and this finding was more common in patients
co-infected with hepatitis C. None of the recipients became antigenemic
(HBsAg-positive) or developed clinical hepatitis B posttransplantation.
Thus, prophylactic intervention (eg, antiviral or antinucleoside analog
therapy) is not warranted after liver transplantation in HBsAg-negative,
anti-HBc-positive recipients. In our experience, infected donor livers are
the most common source of de novo posttransplantation hepatitis B infection
in transplant recipients. (Liver Transpl 2003;9:1253-1257.)

   Publishing and Reprint Information  TOP


From the *Division of Gastroenterology and Hepatology, Mayo Clinic,
Scottsdale, AZ, the ?Division of Gastroenterology, Hepatology, and Internal
Medicine, and the ?Department of Biochemistry and Molecular Biology, Mayo
Clinic, Rochester, MN, and the §Division of Transplantation Medicine, Mayo
Clinic, Scottsdale, AZ.

Address reprint requests to David D. Douglas, MD, Division of
Transplantation Medicine, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix,
AZ 85054. Telephone: 480-342-0517; FAX: 480-342-2324; E-mail:
[email protected]

Copyright © 2003 by the American Association for the Study of Liver Diseases


1527-6465/03/0912-0003$30.00/0

doi:10.1016/j.lts.2003.09.013