Study On The Correlation Between Liver Histopathology And HBV DNA Level In Patients With HBV Infection After OLT

It is well accepted that the orthotopic liver transplantation(OLT)is the definitive therapy for patients with end-stage liver disease, and the graft HBV infection is the one of major complications. The graft HBV infection can be diagnosed rapidly through detection of serum HBV-antigen, HBV DNA or immunohistochemical staining. But the histological appearance is nonspecific usually, because cholestatic, portal inflammation, lytic necrosis and other pathological changes can be results of many other complications such as allograft rejection, preservation injury and so on. When the pathological changes are atypical, diagnose become more difficult. it is necessary to understand the pathological difference between the graft HBV infection and allograft rejection.In chronic hepatitis, hepatocyte degeneration and histological damage followed the cell-mediated immunity injury. HBV has no direct harm to hepatocytes, serum and liver HBVDNA load have no correlation with liver histological damage. But in OLT patients with HBV infection, the immunologic factor may not be the main reason to the graft pathological damage Under the MHC-noncompliance and immunosuppression situation. In clinic, Anti-virus therapies can effectively control the HBV replication and progression of hepatitis and improve the survival rate and time of patients. Some graft HBV infection patients may develop to fibrosing cholestatic hepatitis(FCH) due to HBV DNA high-replication and virus antigen over-expression.Based on the research mentioned above, we suppose the serum HBV DNA high-replication and hepatic tissue virus load may be corelative with the histological damage in the graft HBV infected patients. To testify the hypothesis, patients with graft HBV infection were enrolled and administrated with anti-virus medicine. First the pathologic characters between graft HBV infection and acute rejection were evaluated in order to show the difference. Second, Liver biopsy, serum ALT, HBV antigen and HBVDNA were analysised in each patients before and after treatment, the immunohistochemitic staining, histological assessment using HAI scoring system and PCR quantification of intrahepatic HBV DNA were performed simultaneously. Main results:1,In hepatocyte hydropic degeneration, cholestatic, spotty, focal necrosis and portal inflammation, there was no obvious difference between the graft HBV infection and acute rejection patients. In contrast significant difference in bile duct epithelial and vascular endothelial cell damage and piecemeal necrosis could be observed. In rejection case, portal area was infiltrated with mixed inflammatory cells containing many monocytes, lymphocytes and occasional neutrophils, eosinophils. In graft HBV infection patients, we do not observe the neutrophils and eosinophils in the portal area. 2,after the anti-virus therapy, the graft histological damage was lessened with decrease of serum and intrahepatic HBV DNA in the responding group. In contrast, without obviously changes of serum and intrahepatic HBV DNA, damage was not lessened in nonreponding group. There were no difference in expression of HBsAg and HBcAg in liver tissues between the two groups.The result shows serum and intrahepatic HBV virus load may be correlative with the histological damage in the graft HBV infected patients. 3,Anti-virus therapy after graft HBV infection can inhibit effectively the HBV DNA replication, and whereafter, lessen injury of hepatic tissue. ADV can inhibit the Lam-resistant strains significantly, at the same time, there maybe exists the Adv-resistant virus strains too.