Serum hepatitis B virus DNA before liver transplantation correlates with HBV reinfection rate even under successful low-dose hepatitis B immunoglobulin prophylaxis

• Published in: Hepatology international 2011-12, Vol.5 (4), p.918-926
• Main Authors: Yasunaka, Tetsuya, Takaki, Akinobu, Yagi, Takahito, Iwasaki, Yoshiaki, Sadamori, Hiroshi, Koike, Kazuko, Hirohata, Satoshi, Tatsukawa, Masashi, Kawai, Daisuke, Shiraha, Hidenori, Miyake, Yasuhiro, Ikeda, Fusao, Kobashi, Haruhiko, Matsuda, Hiroaki, Shinoura, Susumu, Yoshida, Ryuichi, Satoh, Daisuke, Utsumi, Masashi, Onishi, Teppei, Yamamoto, Kazuhide
• Format: Article
• Language: English
• Subjects: Colorectal Surgery; DNA; Hepatitis B; Hepatitis B virus; Hepatology; Immunoglobulins; Medicine; Medicine & Public Health; Original; Original Article; Prophylaxis; Surgery
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-011-9265-z

Purpose The combination of hepatitis B immunoglobulin (HBIg) and nucleos(t)ide analogues has been accepted as the best treatment to control hepatitis B recurrence after orthotopic liver transplantation (OLT). However, the optimal dose of HBIg remains unclear. We have previously reported that high-dose HBIg in the early period followed by low-dose HBIg with nucleos(t)ide analogues offers reliable and cost-effective control of hepatitis B recurrence. The aim of this study was to investigate intrahepatic hepatitis B virus (HBV) reinfection status with our clinically successful protocol. Methods We quantified levels of intrahepatic HBV covalently closed circular (ccc) deoxyribonucleic acid (DNA) and serum hepatitis B core-related antigen (HBcrAg), a new serological marker that can estimate intrahepatic cccDNA levels. Nucleos(t)ide analogues were administered in all cases. Results No patients showed recurrence of hepatitis B surface antigen (HBsAg) or HBV-DNA. However, HBV, cccDNA, and HBcrAg were positive in 57% and 48% of patients after OLT, respectively. Pre-OLT serum HBV-DNA and HBcrAg levels correlated linearly with post-OLT cccDNA levels ( r  = 0.534, P  4 log 10  IU/mL, respectively, at the time of OLT, were associated with high levels of post-OLT cccDNA. Even with our successful protocol, nearly half of patients showed HBV reinfection. Conclusions Patients with high serum HBV-DNA and HBcrAg levels before OLT (particularly >3 log 10 copies/mL and >4 log 10 IU/mL, respectively) should be followed with care for HBV recurrence.