Hepatitis B virus infection after renal transplantation in the presence of antibody to hepatitis B surface antigen immunity.
OBJECTIVE
Hepatitis B virus (HBV) infection has been known to be hampered by immunity against hepatitis B surface antigen (HBsAg). However, HBV with mutations within the common antigenic epitope of HBsAg, the "a" determinant region, can escape from humoral immunity. Moreover, HBV infection by "a" determinant mutants in chronic HBV patients has been reported after renal transplantation. In the present study, the authors investigated HBV infection after renal transplantation despite passive immunization or resolved HBV infection.


METHODS
A total of 1682 patients who underwent a renal transplant between 1979 and 1998 at the Severance Hospital, Yonsei University College of Medicine, Korea, were enrolled. The sequence of the HBV genome was analyzed from two patients with antibody to HBsAg (anti-HBs) immunity.


RESULTS
Of 1682 patients who were HBsAg negative before transplantation, 21 patients were found to be HBsAg positive, with elevated aspartate aminotransferase and alanine aminotransferase levels after transplantation. Interestingly, six of 21 (28.6%) patients were anti-HBs positive before the transplantation. Sequence analysis of the cloned HBV from two of six patients with anti-HBs immunity showed no evidence of significant mutations within the "a" determinant region, suggesting a wild-type of HBV. Their donors were not exposed to HBV before transplantation (all HBV markers were negative). Seven deaths of 21 patients were ascribed to HBV-related complications.


CONCLUSIONS
Regardless of anti-HBs immunity, HBV infection occurred in immunosuppressed patients in a high endemic area. The molecular mechanism and clinical impact of HBV infection after renal transplantation in patients with anti-HBs immunity should be further reappraised.
Kim
Kyun-Hwan
KH
Yonsei Medical Research Center and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Ahn
Sang Hoon
SH
Chung
Hyo Young
HY
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Kim
Yu Seun
YS
Chon
Chae Yoon
CY
Moon
Young Myoung
YM
Han
Kwang-Hyub
KH
D000328:Adult; D000595:Amino Acid Sequence; D001483:Base Sequence; D002986:Clinical Trials as Topic; D005260:Female; D006509:Hepatitis B / Q000209:etiology* / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007109:Immunity; D016030:Kidney Transplantation / Q000009:adverse effects*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens