title: Hepatitis B virus sequence changes evolving in liver transplant recipients with fulminant hepatitis.
abstract: OBJECTIVE
  Patients undergoing liver transplantation for hepatitis B virus (HBV) related liver cirrhosis are at major risk of developing HBV recurrence, and occasionally fulminant hepatitis. Here we tested in a longitudinal study whether specific viral variants are associated with fulminant HBV infection in the graft.
  
  
  METHODS
  The complete HBV genomes isolated from the sera of three patients with HBV and HBV and hepatitis delta virus (HDV) coinfection during chronic infection before and during fulminant reinfection after transplantation were amplified and directly sequenced.
  
  
  RESULTS
  Twenty, 25 and 19 mutations, distributed over the entire genome, were identified which differed between the HBV genomes isolated from each patient during chronic and fulminant infection, respectively. This reflects a much higher rate of nucleotide sequence changes than expected from the natural variation of HBV. No common HBV mutation emerged in any of the three cases during fulminant infection. However, precore defective viruses were found to be present in all three patients at the time of fulminant infection and in two of the patients before fulminant infection. Two of the patients had preS2-defective HBVs both before and after transplantation. A point mutation in the 'a'-determinant of the surface protein emerged in one case after transplantation under treatment with polyclonal HBV specific immunoglobulins.
  
  
  CONCLUSIONS
  Many new, but no specific common mutations emerged during fulminant HBV reinfection. Although HBeAg defective variants were found in all cases studied, the presence of these variants also during chronic infection in two cases demonstrates that they are not sufficient to cause fulminant hepatitis. Thus, other factors than the emergence of a specific viral strain seem to contribute to the development of fulminant reinfection in a liver graft.
authors.affiliation: Department of Medicine, Heinrich Pette Institut fur Experimentelle Virologie und Immunologie Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sterneck
authors.forename: S
authors.initials: S
authors.lastname: Günther
authors.forename: J
authors.initials: J
authors.lastname: Gerlach
authors.forename: N V
authors.initials: NV
authors.lastname: Naoumov
authors.forename: T
authors.initials: T
authors.lastname: Santantonio
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: X
authors.initials: X
authors.lastname: Rogiers
authors.forename: H
authors.initials: H
authors.lastname: Greten
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: H
authors.initials: H
authors.lastname: Will
mesh_terms: D000328:Adult; D000595:Amino Acid Sequence; D001483:Base Sequence; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D016679:Genome, Viral; D018963:Hepatitis Antigens / Q000032:analysis; D006509:Hepatitis B / Q000601:surgery* / Q000821:virology*; D006512:Hepatitis B Core Antigens / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics*; D003698:Hepatitis Delta Virus / Q000276:immunology; D006801:Humans; D008099:Liver / Q000276:immunology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014764:Viral Proteins / Q000235:genetics
chemical_list: D004279:DNA, Viral; D018963:Hepatitis Antigens; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D014764:Viral Proteins