Background/Aims: Recurrent hepatitis B virus (HBV) infection is the leading cause of mortality and morbidity after orthotopic liver transplantation (OLT) for HBV-related liver disease, but the extent of viral genetic variation in this setting remains unknown. Methods: Eight patients who underwent OLT for HBV-related liver disease were studied; 7 had cirrhosis and 1 had fulminant hepatitis. Four patients received long-term hepatitis B immunoglobulin prophylaxis. A 240-base pair fragment (1742-1981) comprising the precore region of HBV was amplified by polymerase chain reaction from sera drawn before OLT and 6,12, and 24 months after OLT and analyzed. Results: All sera were positive by polymerase chain reaction. Nucleotide sequence variations were congruent within most patients before and after OLT; however, in one patient, substantial sequence variation was observed, suggesting infection with a new HBV strain. No sequence variation associated with a particular outcome could be identified. Two patients harbored HBV variants with a deletion or insertion upstream of the precore messenger RNA initiation site. Conclusions: Reinfection after OLT can occasionally be caused by HBV strains different from the one present before OLT. Changes within the sequenced region are not predictive of the outcome of reinfection.
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