PRETRANSPLANTATION INTERFERON TREATMENT AND RECURRENCE OF HEPATITIS-B VIRUS-INFECTION AFTER LIVER-TRANSPLANTATION FOR HEPATITIS-B RELATED END-STAGE LIVER-DISEASE

Orthotopic liver transplantation in patients with hepatitis B-related cirrhosis is commonly complicated by reinfection with the hepatitis B virus, with rapidly progressive liver disease and poor survival rate. We assessed the efficacy of prior therapy with recombinant interferon-alpha on the prevention of posttransplantation hepatitis B virus reinfection. Twenty-two patients with hepatitis B-related cirrhosis waiting for liver transplantation received 3 MU (decreased to 1.5 MU in cases of intolerance) of recombinant interferon-alpha until transplantation. The rates of posttransplantation hepatitis B virus reinfection and survival in this group were compared with those in a group of 26 patients previously given transplants for the same disease but not given interferon therapy. The same protocol of HBs antibody passive immunoprophylaxis was applied after transplantation in both groups. Recombinant interferon-alpha was administered for 14 +/- 7 wk. The treatment had an antiviral effect, with disappearance of serum hepatitis B virus DNA in seven of the eight patients initially positive for hepatitis B virus DNA and disappearance of HBeAg in two of the three patients initially positive for HBeAg. Serum hepatitis B virus DNA remained detectable with polymerase chain reaction at transplantation in 56% of the interferon-treated patients. After transplantation, hepatitis B virus reinfection was more frequent in polymerase chain reaction-positive than in polymerase chain reaction-negative patients (78% vs. 17%, p < 0.05). One patient's condition deteriorated during interferon treatment; this patient was not given a transplant. Two patients (in whom hepatitis B virus DNA disappeared from serum) improved so markedly during treatment that they were not given transplants. The rates of posttransplant hepatitis B virus reinfection (44% and 58%, respectively), the delay of hepatitis B virus reinfection (8 +/- 5 mo and 6 +/- 3 mo, respectively) and the survival rates (83% and 69%, respectively) were not statistically different in the interferon-treated and untreated groups. We conclude that, in patients with hepatitis B-related cirrhosis, pretransplantation recombinant interferon-alpha, at the dosage and duration we used, has an antiviral effect but does not prevent posttransplantation hepatitis B virus reinfection. Detection of serum hepatitis B virus DNA with polymerase chain reaction before transplantation might be useful in predicting reinfection after transplantation.