title: Hepatitis B virus with antigenically altered hepatitis B surface antigen is selected by high-dose hepatitis B immune globulin after liver transplantation.
abstract: "Escape" variants of hepatitis B virus (HBV) can cause infection despite previous immunization. These viruses show alterations of the immunogenic major hydrophilic loop of the HBV small surface protein (s-protein). We studied whether HBV "escape" variants were selected in patients with graft infection after liver transplantation for HBV-related diseases who received passive immunoprophylaxis with high-dose polyclonal hepatitis B hyperimmune globulin (HBIG). For that, pre- and posttransplantation sera of 34 patients were analyzed for the occurence of HBV S-gene variants. In addition, binding of in vitro-translated variant s-proteins to HBIG was studied. Variants with exchanges of amino acid (aa) 144 (s144) in HBV genotype A and 145 in genotype D (s145) were found to emerge, persist, and predominate during HBIG, and thus fulfilled criteria of "escape" variants selected. In addition to already-known variants sG145R/K/E, we could demonstrate that newly described variants sX144G and sG145A were antigenically altered and showed impaired recognition by polyclonal HBIG in vitro. Diminished recognition of variant s-proteins correlated with the failure of HBIG to prevent infection of the liver graft with antigenically altered variant HBV Patients infected with "escape" variants s144 or s145 showed a worse clinical outcome compared with the other patients on high-dose, long-term HBIG prophylaxis (44% vs. 23% graft failure caused by HBV infection). Our results suggest that antigenically altered HBV variants s144 and s145 can be selected by HBIG and can influence clinical outcome after liver transplantation.
authors.affiliation: First Medical Department, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Protzer-Knolle
authors.forename: U
authors.initials: U
authors.lastname: Naumann
authors.forename: R
authors.initials: R
authors.lastname: Bartenschlager
authors.forename: T
authors.initials: T
authors.lastname: Berg
authors.forename: U
authors.initials: U
authors.lastname: Hopf
authors.forename: K H
authors.initials: KH
authors.lastname: Meyer zum Büschenfelde
authors.forename: P
authors.initials: P
authors.lastname: Neuhaus
authors.forename: G
authors.initials: G
authors.lastname: Gerken
mesh_terms: D000328:Adult; D000595:Amino Acid Sequence; D001483:Base Sequence; D014644:Genetic Variation / Q000235:genetics; D006084:Graft Rejection / Q000821:virology; D006509:Hepatitis B / Q000150:complications / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000235:genetics* / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D007116:Immunization, Passive; D016031:Liver Transplantation; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D011182:Postoperative Care; D014764:Viral Proteins / Q000235:genetics / Q000276:immunology
chemical_list: D006514:Hepatitis B Surface Antigens; D014764:Viral Proteins