OBJECTIVE: To investigate the dynamic alternations of HBV markers of active HBV replication recipients receiving lamivudine prophylaxis after liver transplantation.
METHODS: Serial liver biopsy samples and sera were obtained from 15 recipients and examined with enzyme-linked radioimmunoassay for HBsAg, HBeAg, HBsAb, HBcAb and HBeAb, and fluorescent quantitative assay for quantitation of HBV DNA in serum. Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ were used to detect HBV markers in liver biopsy samples.
RESULTS: 100 mg lamivudine taken orally every day for 2 weeks before transplantation enabled 12 (80%) of 15 active viral replication recipients (HBV DNA positive) to converse to HBV DNA negative. HBsAb, HBcAb and HBeAb in serum emerged in 1-2 weeks after liver transplantation, and disappeared gradually within 6 months; HBV DNA fluorescent quantitative assay showed constant negativity in serum. Immunohistochemical staining of HBsAg, HBcAg and HBV DNA hybridization in situ in liver biopsy samples showed negative results synchorously. Eight of the 15 HBV active replication recipients lost HBV markers thoroughly both in serology and tissue staining as well as HBV DNA hybridization in situ of serial liver biopsy samples from 12 to 44 weeks after liver transplantation. Should any of HBsAg, HBeAg in serology and HBsAg, HBcAg in immunohistochemical staining was positive, or HBV DNA detectable in serum, or HBV DNA hybridization in situ in liver tissue positive, allograft HBV reinfection or De novo liver allograft infection could be diagnosed. Furthermore, if associated with elevation of ALT and bilirubin, the diagnosis of HBV hepatitis recurrence could be established.
CONCLUSION: Allograft HBV reinfection or De novo liver allograft infection in active viral replication recipients could be prevented with lamivudine regimen, and further clearance of HBV may be possible if proper measures are taken.