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

Abstract

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.

Case Report of Lamivudine-Resistant Hepatitis B Virus Infection Post Liver Transplantation from a Hepatitis B Core Antibody Donor

“…In addition, loss of antiHBs is not uncommon following LT, even in patients with previous HBV exposure. One study reported the loss of anti-HBs post LT in 31% patients with pretransplant antiHBs and anti-HBc (14). Our patient experienced loss of antiHBs after LT despite short-term HBIg treatment and the presence of pre-LT anti-HBs.…”

“…Thus, donor anti-HBs status does not need to be considered when assessing risk for de novo post-LT HBV infection. In addition, the presence of anti HBc (in the absence of hepatitis B surface antigen (HBsAg)) in the recipient prior to transplantation has negligible risk for post-LT HBV infection (13) even in the presence of hepatitis B virus deoxyribonucleic acid (HBV DNA) in the recipient serum or liver tissue (14).…”

Recurrence of occult hepatitis B virus infection in a recipient of a liver transplant for HCV-related cirrhosis: full length genome, mutations analysis and literature review

“…With the development of sensitive molecular tests for HBV in recent years, in various clinical situations low levels of HBV DNA have been detected despite the absence of HBsAg: (a) Transmission trough transfusion 14,15 or transplantation 16,17 (b) Viral reactivation in patients under condition of immunosuppression. 18,19 (c) Chronic hepatitis of unknown aetiology, 4 in HCC 20 and the highest prevalence in HCV patients.…”

“…Several studies of occult HBV infections have reported that the frequency of HBV DNA was higher in liver than in sera. 5,17,26 However, in some case of occult HBV infection, HBV DNA was positive in serum but not detected in the liver. Alternatively, other locations may support on-going HBV replication.…”

“…27,28 Recent studies suggested recurrence of HBV infection both in positive or negative HBsAg patients after the removal of the infected liver and the implantation of the new, uninfected one. 17,29 Abdelmaleck et al reported that among 10 patients AgHBs negative but with detectable HBV DNA in liver before transplantation, 4 had HBV DNA in the liver posttransplantation without associated clinical hepatitis or HBsAg in sera and this was most likely to occur in patients who were co-infected with HCV. 17 However, the authors of this study did not perform further analysis to assess whether the HBV infection found in the 4 cases was de novo infection or recurrence of occult HBV infection.…”