Retrospective Study
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World J Gastroenterol. Sep 28, 2014; 20(36): 13159-13166
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13159
Risk factors for de novo hepatitis B infection in pediatric living donor liver transplantation
Wei Rao, Man Xie, Tao Yang, Jian-Jun Zhang, Wei Gao, Yong-Lin Deng, Hong Zheng, Cheng Pan, Yi-He Liu, Zhong-Yang Shen
Wei Rao, Tao Yang, Wei Gao, Yong-Lin Deng, Hong Zheng, Cheng Pan, Yi-He Liu, Zhong-Yang Shen, Jian-jun Zhang, Department of Organ Transplantation, Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
Man Xie, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Rao W and Xie M contributed equally to this work; Rao W and Xie M performed the majority of experiments; Yang T, Gao W and Zhang JJ provided vital reagents and were also involved in editing the manuscript; Deng YL, Zheng H, Pan C and Liu YH co-ordinated and provided the collection of all the human material; Shen ZY contributed to the design and interpretation of the study.
Supported by National High Technology Research and Development Program (863 Program) of China, No. 2012AA021001
Correspondence to: Zhong-Yang Shen, MD, PhD, Department of Organ Transplantation, Tianjin Key Laboratory of Organ Transplantation, Tianjin First Central Hospital, Fukang Road 24, Tianjin 300192, China. shenzhongyangmd@126.com
Telephone: +86-22-23626612 Fax: +86-22-23626612
Received: January 23, 2014
Revised: May 12, 2014
Accepted: June 26, 2014
Published online: September 28, 2014
Abstract

AIM: To investigate the incidence of de novo hepatitis B virus (HBV) infection after pediatric living donor liver transplantation (LDLT) and to analyze the risk factors associated with this de novo HBV infection.

METHODS: The clinical and laboratory data of children who underwent LDLT from June 2010 to September 2012 in First Center Hospital in Tianjin, China, were retrospectively included in the study. Intrahepatic HBV DNA in donors and recipients was quantified by real-time polymerase chain reaction using DNA extracted from formalin-fixed, paraffin-embedded tissues.

RESULTS: Between June 2010 to September 2012, 32 consecutive pediatric patients underwent LDLT in our institute. Thirty LDLT patients (13 girls and 17 boys) were followed up for a median of 15 mo, of whom 53.3% (16/30) were hepatitis B core antibody (HBcAb) positive and 36.7% (11/30) were hepatitis B surface antibody (HBsAb)/HBcAb positive before transplantation. Sixteen of the children received HBcAb-positive allografts, and 43.7% (7/16) of the grafts were found to be intrahepatic HBV DNA positive. De novo HBV infection developed in 16.1% (5/30) of the children within a median of 11 mo after transplantation. All five of the HBV-infected children had received HBcAb-positive allografts, four of which were intrahepatic HBV DNA positive. Two of the children developed de novo HBV infection despite the preoperative presence of both HBsAb and HBcAb

CONCLUSION: In pediatric recipients, positive intrahepatic HBV DNA in allografts could be a risk factor for de novo HBV infection from HBcAb-positive allografts. HBsAb/HBcAb positivity in pediatric LDLT patients before transplantation exhibited only weak effectiveness in protecting them against de novo HBV infection from HBcAb-positive allografts.

Keywords: Pediatric liver donor liver transplantation, Occult hepatitis B infection, De novo hepatitis B infection

Core tip: We reported our experience of de novo hepatitis B virus (HBV) infection after pediatric living donor liver transplantation (LDLT), which showed that the incidence of de novo HBV infection in pediatric LDLT was 16.7% in our center. Among hepatitis B core antibody (HBcAb)-positive allografts, 43.7% were intrahepatic HBV DNA positive. Positive intrahepatic HBV DNA in allografts was predictive of de novo HBV infection after LDLT in children who were given HBcAb-positive allografts. Hepatitis B surface antibody/HBcAb positivity exhibited weak effectiveness in preventing children receiving HBcAb-positive allografts from de novo HBV infection. Lamivudine prophylaxis therapy is essential to prevent de novo HBV infection in pediatric patients from HBcAb-positive allografts with positive intrahepatic HBV DNA.