title: Viral load at the time of liver transplantation and risk of hepatitis B virus recurrence.
abstract: Hepatitis B virus (HBV) recurrence after liver transplantation is significantly reduced by prophylaxis with hepatitis B immune globulins (HBIG) or antiviral drugs in nonreplicating patients and by the combination of both drugs in replicating patients. However, the load of HBV DNA, which defines replicating status in patients undergoing liver transplantation, remains unclear. This study analyzes the correlation between the viral load, tested with a single amplified assay, at the time of liver transplantation, and the risk of hepatitis B recurrence in 177 HBV carriers who underwent transplantation in a single center from 1990 to 2002. Overall, HBV relapsed after surgery in 15 patients (8.5%) with a 5- and 8-year actuarial rate of recurrence of 8% and 21%, respectively. After liver transplantation hepatitis B recurred in 9% of 98 selected subjects treated only with immune globulins and in 8% of 79 viremic patients who received immune globulins and lamivudine (P = NS). A linear correlation was observed between recurrence and viral load at the time of surgery. In transplant patients with HBV DNA higher than 100,000 copies/mL, 200-99,999 copies/mL, and DNA undetectable by amplified assay, hepatitis B recurred in 50%, 7.5%, and 0% of patients, respectively. Overall, a viral load higher than 100,000 copies/mL at the time of liver transplantation was significantly associated with hepatitis B recurrence (P = .0003). In conclusion, spontaneous or antiviral-induced HBV DNA viral load at the time of surgery classifies the risk of HBV recurrence after liver transplantation and indicates the best prophylaxis strategy.
authors.affiliation: Department of Gastroenterology, San Giovanni Battista Hospital, Turin, Italy. alfredomarzano@yahoo.it
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
authors.forename: Silvia
authors.initials: S
authors.lastname: Gaia
authors.forename: Valeria
authors.initials: V
authors.lastname: Ghisetti
authors.forename: Silvia
authors.initials: S
authors.lastname: Carenzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Premoli
authors.forename: Wilma
authors.initials: W
authors.lastname: Debernardi-Venon
authors.forename: Carlo
authors.initials: C
authors.lastname: Alessandria
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchello
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000601:surgery*; D006515:Hepatitis B virus; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin