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Significance of Hepatitis B Virus Genotype in Liver Transplantation for Chronic Hepatitis B
Author(s) -
Lo Chung Mau,
Cheung Cindy K.,
Lau George K.,
Yuen Man Fung,
Liu Chi Leung,
Chan See Ching,
Fan Sheung Tat,
Wong John
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.00952.x
Subject(s) - genotype , lamivudine , medicine , liver transplantation , hepatitis b virus , transplantation , gastroenterology , hepatitis b , bdna test , liver disease , hbeag , hbsag , virology , immunology , viral load , virus , biology , gene , genetics
Hepatitis B virus (HBV) genotype influences chronic hepatitis B disease profile but its relevance in liver transplantation (LTx) is not known. HBV genotype was identified by direct sequencing from pre‐transplant sera of 119 patients who underwent LTx using lamivudine prophylaxis (genotype A,1; B,43; C,74; D,1). The baseline characteristics and outcome of 43 genotype B and 74 genotype C patients were compared. Genotype B patients had significantly more pre‐transplant acute flare, worse liver functions and higher model for end‐stage liver disease score. Fewer genotype B patients had HBeAg (13% vs. 32%; p = 0.017), but HBV DNA seropositivity (by bDNA assay) was comparable (26% vs. 23%; p = 0.727). The 3‐year graft survival was 83% for genotype B and 89% for genotype C (p = 0.2). The rate of HBsAg clearance or seroreversion was the same. The cumulative rate of viral breakthrough due to lamivudine‐resistant mutants at 3 years was 4% for genotype B and 21% for genotype C (p = 0.017). Liver biopsy after viral breakthrough showed recurrent hepatitis B in 7 of 10 genotype C patients, including 2 with fibrosing cholestatic hepatitis, and no histologic recurrence in 2 genotype B patients. In conclusion, HBV genotypes B and C are associated with different patterns of end‐stage liver diseases that required transplantation, and genotype C may carry a greater risk and severity of recurrence due to lamivudine‐resistant mutants.