De Novo vs. Recurrent Hepatitis B After Liver Transplantation: Clinical Profiles And Functional Cure

This study compares the clinical characteristics and functional cure rates of de novo (DNH) versus recurrent hepatitis B virus (HBV) infections following liver transplantation. Data from 150 adult patients diagnosed with post-transplant HBV between 2010 and 2024 were analyzed, explicitly excluding individuals receiving anti-HBc-positive donor grafts. Participants were stratified by pre-transplant serology into DNH (n = 36) and recurrent HBV (n = 114) cohorts. Clinically, the DNH group experienced more severe acute hepatic injury upon infection, evidenced by elevated median peak bilirubin levels and a remarkably higher incidence of hepatitis B e antigen (HBeAg) positivity at initial diagnosis (86.1% vs. 9.6%, p < 0.001). Despite this severe acute presentation, DNH patients exhibited robust hepatic recovery following antiviral intervention, achieving alanine aminotransferase (ALT) normalization rates comparable to the recurrent group (50.0% vs. 48.2%, p = 1.000). Functional cure, explicitly defined as sustained hepatitis B surface antigen (HBsAg) loss, was achieved in 20.67% (31/150) of the total cohort. Time-to-event Kaplan-Meier survival analysis demonstrated that the recurrent cohort achieved functional cure significantly earlier and at a higher cumulative probability (Log-rank p = 0.037). Crucially, multivariate Cox proportional hazards regression established that combination therapy with hepatitis B immunoglobulin (HBIG) served as a robust independent predictor of definitive functional cure (Adjusted Hazard Ratio = 4.21, p = 0.002), successfully overcoming initial baseline disparities. In conclusion, while DNH manifests as a severe acute infection due to pre-transplant immune naivety, recurrent HBV is associated with a more favorable trajectory toward functional cure. These findings support the implementation of personalized antiviral management, establishing that integrating nucleos(t)ide analogs with low-dose HBIG significantly optimizes definitive serological outcomes.