Significance of hepatitis B virus genotype in liver transplantation for chronic hepatitis B

Am J Transplant. 2005 Aug;5(8):1893-900. doi: 10.1111/j.1600-6143.2005.00952.x.

Abstract

Hepatitis B virus (HBV) genotype influences chronic hepatitis B disease profile but its relevance in liver transplantation (LTx) is not known. HBV genotype was identified by direct sequencing from pre-transplant sera of 119 patients who underwent LTx using lamivudine prophylaxis (genotype A,1; B,43; C,74; D,1). The baseline characteristics and outcome of 43 genotype B and 74 genotype C patients were compared. Genotype B patients had significantly more pre-transplant acute flare, worse liver functions and higher model for end-stage liver disease score. Fewer genotype B patients had HBeAg (13% vs. 32%; p=0.017), but HBV DNA seropositivity (by bDNA assay) was comparable (26% vs. 23%; p=0.727). The 3-year graft survival was 83% for genotype B and 89% for genotype C (p=0.2). The rate of HBsAg clearance or seroreversion was the same. The cumulative rate of viral breakthrough due to lamivudine-resistant mutants at 3 years was 4% for genotype B and 21% for genotype C (p=0.017). Liver biopsy after viral breakthrough showed recurrent hepatitis B in 7 of 10 genotype C patients, including 2 with fibrosing cholestatic hepatitis, and no histologic recurrence in 2 genotype B patients. In conclusion, HBV genotypes B and C are associated with different patterns of end-stage liver diseases that required transplantation, and genotype C may carry a greater risk and severity of recurrence due to lamivudine-resistant mutants.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Drug Resistance, Viral
  • Female
  • Genotype
  • Hepatitis B Surface Antigens / metabolism
  • Hepatitis B e Antigens / metabolism
  • Hepatitis B virus / genetics*
  • Hepatitis B, Chronic / surgery*
  • Hepatitis C / genetics
  • Hepatitis C / therapy
  • Humans
  • Lamivudine / administration & dosage*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Preoperative Care
  • Reverse Transcriptase Inhibitors / administration & dosage
  • Secondary Prevention
  • Treatment Outcome

Substances

  • Hepatitis B Surface Antigens
  • Hepatitis B e Antigens
  • Reverse Transcriptase Inhibitors
  • Lamivudine