Results from a Long Term Histological Follow up of De Novo HBV-infection in Liver Transplant Patients Unrelated to HBV-Reinfection and HBV-Reactivation

Abstract

Introduction The development of hepatitis-B is considered as a serious complication after liver transplantation. It may cause severe graft dysfunction and even lead to graft loss and to patient´s death. HBV-de novo infection is a rather rare phenomenon, however it deserves attention in the era of donor organ shortage. The aim of the present analysis was to examine the course of HBV-infection in liver transplant patients without HBV-associated liver disease pretransplant including long term histological follow-up. Patients and Methods Since 1988 3005 liver transplantations have been performed at Charité, Campus Virchow-Klinikum for various liver diseases. Prevalence of patients with de novo HBV-infection transplanted for other reasons than HBV-associated liver disease was determined in a local transplant data base. Recipients of antiHbc-positive organs were excluded from the analysis. The analysis focused on the moment of HBV-detection and on the long term follow-up in terms of biochemical and histological changes during almost 30 years in a high volume transplant center in Germany. Statistical analysis was performed using SPSS version 24. Results 39 patients were identified with the diagnosis of de novo hepatitis-B (1.3%). None of the patients was transplanted because of HBV-associated liver disease, so that HBV-reinfection was ruled out. Furthermore none of them received an antiHbc-positive organ. Median time from liver transplantation to the diagnosis was 366 (8-5497) days. No fibrosis progression could be detected. Furthermore, steatosis and the grade of inflammation did not significantly change between the time of HBV-infection and the end of histological follow-up for 2897 (106-8045) days in median. Patients with a poor virological control especially in the beginning of the 90ies era before NUCs or low genetic barrier NUCs demonstrated a significantly decreased survival and 1 HBV-associated graft loss. Conclusion Since the introduction of NUCs with high genetic barrier HBV-associated graft infection is a condition that can be controlled very well without significant fibrosis progression, graft loss or patient death if recognized on time within a regular transplant follow-up schedule.