Self‐limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30‐year liver transplant program

Abstract

Background A self‐limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV‐DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end‐stage liver diseases (ESLD) unrelated to HBV are unknown, and recommendations on HBV prophylaxis remain unclear. Patients and methods Among 1273 liver transplants, 168 patients with a self‐limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti‐HBc‐positive liver were not included in the analysis. Demographic, laboratory, serological, and virological data were analyzed retrospectively. Appearance of HBsAg or HBV‐DNA was defined as reactivation. Results The median follow‐up after LT was 12.0 years (0.6‐30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n = 7; 4.2%), the etiology of ESLD, hepatitis C treatment, or the anti‐HBs concentration. The overall patient survival with a history of a self‐limited HBV infection before LT did not significantly differ from the rest of the cohort. Conclusion Antiviral treatment with nucleos(t)ide analogues post‐liver transplantation in order to prevent HBV reactivation in patients with a resolved self‐limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self‐limited hepatitis B prior to LT.

HBsAg seroconversion in de novo hepatitis B virus‐infected paediatric liver transplant recipients with anti‐viral therapy

“…Secondly, the immune system is suppressed in paediatric recipients, these patients are more likely to develop liver failure or cirrhosis. The effectiveness of currently available anti‐viral medication is still unknown 21 . To overcome those two limitations, we carry out a Hepatitis B immunoglobulin (HBIg)‐based strategy to prevent de novo HBV, LAM is added to patients who are over 2 years old and do not achieve the pre‐operative prophylactic target.…”

“…The effectiveness of currently available anti-viral medication is still unknown. 21 To overcome those two limitations, we carry out a Hepatitis B immunoglobulin (HBIg)-based strategy to prevent de novo HBV, LAM is added to patients who are over 2 years old and do not achieve the pre-operative prophylactic target. ETV has a faster effect on HBV DNA reduction and a lower incidence of mutation than LAM.…”