A Pilot Study Of The Importance Of Peripheral Blood Mononuclear Cells In Hepatitis B Recurrence After Liver Transplantation Under Present Prevention Protocol

ObjectiveBy means of long-term quantitative monitoring of HBV DNA content alteration in peripheral blood mononuclear cells(PBMC) of HBV-related recipients intermittently after liver transplantation, exploring the implications of those alteration for preventing liver allograft from HBV reinfection and hepatitis B recurrence. And further to study the importance of PBMC in hepatitis B recurrence after liver transplantation under present prevention protocol by detecting HBV YMDD and cccDNA in PBMC.MethodsBlood specimens taken from 30 recipients intermittently after liver transplantation ,who received lamivudine monoprophylaxis or combined with HBIG , were measured searching for HBV DNA in serum and PBMC by Fluorescence quantitative polymerase chain reaction(FQ-PCR)respectively. HBV markers in serum were tested by ELISA, as well as HBV YMDD and cccDNA in PBMC being detected by PCR simultaneously.Results(1)FQ-PCR detected HBV DNA in the PBMC in 21 of 25 recipients, while HBV DNA, HBsAg, HBeAg remained negative in serum during a mean follow-up of 14.2 months(1-41 months) after liver transplantation . (2) HBV DNA negative in PBMC only in 3 of 25 recipients at a mean of 18.3months(9,13,33,months respectively) after liver transplantation ; one of them has had been HBV DNA negative in PBMC postoperatively. (3)5 recipients among 30 transplants acquired HBV allograft reinfection at a mean time of 17.6months(9-23months) postoperatively during lamivudine monoprophylaxis ,whose HBV DNA logarithmic average content reached 7.823 ± 1.228, 2 of which died of HB recurrence. (4)The study shows it may be more effective by given lamivudine and HBIG than lamivudine monoprophylaxis in preventing HB recurrence.(5)Only 1 case(l/14, 7.1%) presented YMDD mutation in serum but not in PBMC who received lamivudine monoprophylaxis. (6)All 17 specimens examined exhibited no HBV cccDNA in PBMC, including 5 HBV reinfection or HB recurrence subjects.Conclusion(1)Those findings indicated the long-term persistence of HBV DNA in PBMC despite protective measures being taken for prevention HB recurrence; (2)And the quantitative detection of HBV DNA in PBMC may be more valuable in instructing the use of prevention measures and anti-virusagents for prevention HB recurrence; (3)There is no evidence to confirmHBV replication with in PBMC; (4)Lamivudine monoprophylaxis can resultin HBV YMDD mutation; (5) Combined prevention measures withlamivudine and HBIG is superior to lamivudine monoprophylaxis, in termsof prevention efficacy against HBV allograft reinfection and HBrecurrence.