Preliminary results: outcome of liver transplantation for hepatitis B virus varies by hepatitis B virus genotype.

Abstract

Hepatitis B virus (HBV) is a leading cause of liver failure throughout the world. HBV has seven different genotypes based on variations within the viral nucleotide sequence. Initially, patients who underwent liver transplantation for HBV had high recurrence rates and poor survival. Recently, improved outcomes have been reported when patients are administered hepatitis B immunoglobulin (HBIg) infusions to maintain high serum hepatitis B surface antibody titers after transplantation. Unfortunately, recurrence rates are still high in patients with active pretransplant HBV replication. The aims of this study are to evaluate the impact of HBV genotype on pretransplantation HBV replication and posttransplantation HBV recurrence rate, morbidity, and mortality. Sera from 22 patients who underwent transplantation for HBV at our center were tested for HBV genotype by an enzyme-linked immunosorbent assay technique using monoclonal antibodies to the pre-S2 region. All patients were administered HBIg after transplantation; 5 patients were administered both lamivudine and HBIg. HBV genotypes were distributed as follows: genotype A (10 patients), genotype C (6 patients), genotype D (5 patients), and genotype E (1 patient). Pretransplantation HBV replication was most common with genotype A (80%), whereas less so with genotypes C (33%) and D (40%). Nine patients (41%) developed recurrent HBV infection: genotype A (2 patients; 20%), genotype C (3 patients; 50%), and genotype D (4 patients; 80%). Mortality was greatest with genotype D (40%). Our data suggest that patients with genotype A have the lowest risk for HBV recurrence despite having the highest rate of pretransplantation HBV viral replication. Patients with genotype D appear to have the highest risk for HBV recurrence and mortality. Additional larger multicenter studies are needed to confirm these findings.