Reactivation of viral replication after liver resection in patients infected with hepatitis B virus.
OBJECTIVE
To investigate the mechanisms and risk factors underlying postoperative reactivation of hepatitis after liver resection for hepatitis B virus-related hepatocellular carcinoma.


BACKGROUND
Although risk factors for acute hepatic failure after liver resection have been reported in patients with chronic liver disease, the issue of reactivation of hepatitis B virus replication after liver resection is unresolved.


METHODS
Fifty-five patients with hepatocellular carcinoma and hepatitis B surface antigen underwent liver resection. In 25 of these 55 patients, serum levels of hepatitis B virus DNA and the type of hepatitis B virus were determined before and after surgery.


RESULTS
Postoperative hepatitis occurred in 13 of the 55 patients (24%). Reactivation of viral replication occurred after liver resection in 7 of the 25 patients tested, and alanine aminotransferase activity increased in 6 of these 7 patients. High preoperative alanine aminotransferase activity, high levels of hepatitis B virus DNA, presence of wild-type DNA, and detection of hepatitis B core antigen in hepatocytes, all features of the immune clearance phase in the natural course of hepatitis B virus infection with no surgery, were more likely to be found in patients with reactivation than in patients without reactivation.


CONCLUSIONS
During the immune clearance phase of hepatitis B virus infection, especially the period of acute exacerbation, changes in serum hepatitis B virus DNA level should be monitored for early warnings of reactivation of viral replication, likely to cause severe postoperative hepatitis and acute hepatic failure.
Kubo
S
S
Second Department of Surgery, Osaka City University Medical School, Osaka, Japan.
Nishiguchi
S
S
Hamba
H
H
Hirohashi
K
K
Tanaka
H
H
Shuto
T
T
Kinoshita
H
H
Kuroki
T
T
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006498:Hepatectomy; D006509:Hepatitis B / Q000276:immunology*; D006511:Hepatitis B Antigens / Q000032:analysis; D006801:Humans; D008099:Liver / Q000276:immunology*; D008113:Liver Neoplasms / Q000601:surgery / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014779:Virus Replication
D004279:DNA, Viral; D006511:Hepatitis B Antigens; D000410:Alanine Transaminase