DIFFERENT COURSES OF HBV INFECTION AFTER LIVER TRANSPLANTATION

Abstract

To compare clinical and virologic course of de novo and recurrent HBV infection 104 liver graft recipients with 6 months and more follow-up after cadaveric transplantation have been analyzed. Recurred HBV infection occurred in 7 (30.4%) out of 23 HBsAg-positive and de novo HBV infection – in 11 out of 81 (13.6%) HBsAg- negative recipients. HBeAg and IgM anti-HBc appeared in 8 recipients with de novo and in one case – with recurrent infection. Two recipients with de novo HBV developed acute hepatitis with jaundice and one – chronic hepatitis with graft cirrhosis. Only one recipient with recurrent HBV developed severe acute hepatitis HBV/ HDV, with anti-HBs seroconversion after 12 weeks of peginterferon alfa treatment. Nucleoside analogs (NA) were started in all 11 de novo HBV cases and in 5 cases of recurrent HBV infection. Treatment with NA effec- tively suppressed HBV DNA replication in both recurrent and de novo infections; HBsAg clearance occurred in 64% of de novo HBV and in 20% – of recurrent HBV cases. No secondary drug resistance occurred. De novo HBV infection is a self-limited disease in most cases, and preemptive NA treatment is the best treatment choice. Recurrent HBV infection is usually chronic, and pegylated interferon may be under consideration as well as NA.

Keywords

• liver transplantation
• pegylated interferon
• hbv de novo
• recurrent
• preemptive therapy.