Hepatitis B virus infection in liver allografts

Area of Science:

• Hepatology
• Virology
• Transplantation Immunology

Background:

• Hepatitis B virus (HBV) recurrence post-liver transplantation (LT) in HBsAg-positive patients leads to significant morbidity and mortality.
• Understanding the clinical and histological outcomes of HBV recurrence is crucial for managing these complex cases.

Purpose of the Study:

• To evaluate the outcomes of liver transplantation in HBsAg-positive patients.
• To characterize the histological findings and clinical course of hepatitis B (HB) recurrence in liver allografts.

Main Methods:

• Retrospective analysis of eight HBsAg-positive patients undergoing liver transplantation.
• Review of clinical data, serological markers, and liver biopsy findings.

Main Results:

• Six of eight patients experienced HB graft infection, with varied histological outcomes including acute hepatitis, fibrosing cholestatic hepatitis, chronic active hepatitis, cirrhosis, and a carrier state.
• Fibrosing cholestatic hepatitis was rapidly progressive, leading to liver failure.
• Perioperative HB immunoglobulin was ineffective in preventing recurrence.
• One patient developed de novo HBsAg positivity post-retransplantation with severe hepatitis.

Conclusions:

• Hepatitis B recurrence in liver allografts is frequent and associated with diverse, often severe, pathological changes.
• The HB virus may exert direct cytopathic effects on liver allografts.
• Current prophylactic measures, including HB immunoglobulin, may not be sufficient to prevent recurrence.