Long-term prevention of virus recurrence among recipients with HBV active replication following liver transplantation

Abstract

Objective To investigate the long-term prophylactic outcome in recipients with HBV active replication under LAM or/and HBIG prophylaxis after liver transplantation. Methods The liver biopsy specimens and serum samples were collected during the follow-up. ELISA and chemiluminesent microparticle immunoassay, HBV-DNA fluorescent quantification, immunohisto-chemisty and HBV-DNA in situ hybridization were performed for analysis. The alteration of HBV markers in serial biopsy and sera of 55 recipients were investigated retrospectively. Results The mean time of follow-up was 69.14 months. Twelve cases had hepatitis B virus reinfection after transplanta-tion. The accumulated ratio of hepatitis B virus reinfection was 4.8%(2/42)in LAM+ HBIG group and 76.9%(10/13) in LAM monopropyhlaxis group (P=0.000). The 1-,2-,3- and 4-y survival rates in combined prophylaxis group were 100%, 97.1%, 92.7% and 92.7%, respectively. The 1-,2-,3- and 4-yr survival rates in LAM mono prophylaxis group were 76.9%, 69.2%, 53.8% and 46.2&, re-spectively (P=0.000). The rates of hepatitis B virus reinfection in combination prophylaxis group (1-,2-,3- and 4-yr recurrence rates of 2.4%, 2.4%, 2.4% and 8.5%, respectively) was markedly lower than those in mono prophylaxis group(1-, 2-, 3- and 4-yr recurrence rates of 16.1%, 41.3 %, 66.4% and 66.4%, respectively)(P=0.000). Conclusion Currently HBIG combined with LAM is an optimal prophylatic protocol to reduce the hepatitis B virus reinfection rate. However, poor compli-ance of recipients to a prescribed course of prophylaxis as well as viral status itself is still the main cause of hepatitis B virus reinfection after liver transplantation in China. Compliance education and ad-justing the prophyiatic protocols according to the viral alteration after liver transplantation may help to further decrease the hepatitis B virus reinfection rate. Key words: Liver transplantation; HBV marker; Reinfection