The
clinical course of 10
liver transplant recipients who had hepatitis B virus (HBV) and five recipients with HBV and D (
delta) infection before
transplantation is described. Six patients who underwent eight transplants died. The estimated one and two year survival rates in patients with HBV only before
transplantation were 74% and 67% respectively. The estimated one and two year survival in patients with HBV and HDV
infection beforehand was 100%. Graft
infection by HBV occurred in 8 of 10 patients infected with HBV only; and in 4 of 5 patients with previous HBV and HDV
infection. There was a widely variable time from
transplantation to the appearance of HBV markers in liver or serum, ranging from 6-331 days.
Hepatitis D antigen (
HDAg) appeared in three grafts very rapidly after
transplantation at 4, 8, and 37 days respectively. Graft
infection by HBV was accompanied by significant liver injury in six allografts in five recipients. In particular, there was a striking morphological appearance in five infected livers in which the hepatocytes became progressively enlarged and distorted as they accumulated huge amounts of
hepatitis B surface and core
antigens (
HBsAg,
HBcAg). These features were accompanied by pericellular
fibrosis and
cholestasis but little associated
inflammation. This syndrome carried a poor prognosis. A gradual progression to
cirrhosis occurred in one additional liver. Finally, recurrent HBV
infection was a principal or a contributing factor in all deaths. The presence of
HBcAg and
inflammation in he native liver increased the risk of HBV induced tissue damaged in the graft whereas HDV
infection in the host liver seemed to reduce the risk of significant HBV induced tissue damage in the allograft. These data suggest that post transplant HBV
infection is accompanied by a variety of changes in the liver allograft, some of which are unique to the transplanted liver and may result in impaired allograft function.