Clinical course of de novo hepatitis B infection after pediatric liver transplantation.
The characteristics of hepatitis B virus (HBV) in vaccinated children who acquire de novo HBV infections after orthotopic liver transplantation (OLT) remain largely unknown. The aim of this study was to explore HBV mutants in pediatric OLT recipients with de novo HBV infections. In all, 50 recipients underwent OLT between December 1997 and October 2005, and they were regularly checked for HBV serum markers from November 2005 to April 2009. Before OLT, all were hepatitis B surface antigen (HBsAg)-negative and under the coverage of the universal infant HBV vaccination program. Those who became HBsAg-positive after OLT were diagnosed with de novo HBV infection. HBV viral loads and full-length genome sequencing were determined when the diagnosis of de novo HBV infection was established. Nine patients (9/50, 18%) acquired de novo HBV infections after OLT. None had graft loss or fulminant hepatitis. Five cleared HBsAg, and 4 of the 5 even recovered with antibody to hepatitis B surface antigen (anti-HBs) formation. The other 4 were persistently HBsAg-positive. Mutations in the major S gene (681 base pairs) were discovered in 8 (88.9%) of the de novo HBV-infected children. Six of them harbored mutations within the "a" determinant region (codons 124-147), whereas the other 2 had mutations outside this region. These 2 cleared HBsAg and recovered with anti-HBs formation. HBV DNA levels were not different between those who cleared HBsAg and those who did not. In conclusion, surface mutants are frequent among pediatric liver transplant recipients with de novo HBV infections, but their clinical relevance requires further study.
Su
Wei-Ju
WJ
Department of Pediatrics, National Taiwan University College of Medicine and Hospital, Taipei 100, Taiwan.
Ho
Ming-Chih
MC
Ni
Yen-Hsuan
YH
Wu
Jia-Feng
JF
Jeng
Yung-Ming
YM
Chen
Huey-Ling
HL
Wu
Yao-Ming
YM
Hu
Rey-Heng
RH
Chang
Mei-Hwei
MH
Lee
Po-Huang
PH
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D017093:Liver Failure / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D009154:Mutation; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D013624:Taiwan / Q000453:epidemiology; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome
D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines