The role of HBV genotype core promoter and precore mutations in advanced liver disease in renal transplant recipients☆

Received 9 May 2008; received in revised form 12 September 2008; accepted 24 September 2008. published online 14 November 2008.

Background/Aims

In renal transplant recipients (RTRs), chronic hepatitis B virus (HBV) infection may lead to poor outcomes. This study aimed to investigate the role of the HBV genotype, core promoter and precore mutations in advanced liver disease in RTRs.

Methods

We retrospectively reviewed 51 RTRs positive for hepatitis B surface antigen (HBsAg). HBV genotype determination and direct sequencing of core promoter and precore regions were performed using the baseline and end-of-follow-up sera post-renal transplantation.

Results

Alanine Transaminase (ALT) and HBV DNA levels were elevated after transplantation (66%). HBV genotypes B and C were found in 45 (88%) and 6 (12%) patients, respectively. There was no significant association of cirrhosis development with ALT, and hepatitis B-e antigen (HBeAg) levels, type of immunosuppressant, HBV genotype, T1762/A1764 and A1896 mutations, and duration of follow-up, except endpoint HBV DNA levels (⩾105copies/ml). High T1762/A1764 mutation rates were associated with high HBV DNA levels (P=0.036) at the endpoint.

Conclusions

HBV DNA replication was enhanced in RTRs with T1762/A1764 mutation. Increased serum HBV DNA levels were associated with cirrhosis development. T1762/A1764 mutation and cirrhosis development did not show significant correlation because of small sample size and/or interventional anti-viral therapies during follow-up.

Associate Editor: R.P. Perrillo

Abbreviations: RTRs, renal transplant recipients, HBV, hepatitis B virus, HBsAg, hepatitis surface antigen, ALT, alanine aminotransferase, LC, liver cirrhosis, BCP, basal core promoter, PC, precore

Keywords: Renal transplantation, HBV genotype, Hepatitis B virus, Core promoter and precore mutations, Liver cirrhosis

1 Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan

2 Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan

3 Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan

Corresponding author. Tel.: +886 7 7317123x8301; fax: +886 7 7322402.

☆ The authors declare that they do not have anything to disclose regarding funding from industries or conflict of interest with respect to this manuscript.

PII: S0168-8278(08)00713-7

doi:10.1016/j.jhep.2008.09.013

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