"Occult" hepatitis B virus as source of infection in liver transplant recipients

Lancet. 1994 Jan 15;343(8890):142-6. doi: 10.1016/s0140-6736(94)90934-2.


Hepatitis B virus (HBV) infection almost always recurs after liver transplantation in patients who were surface antigen (HBsAg) positive before surgery but apparent de novo acquisition of infection in a transplant setting has not previously been reported. We have used sensitive techniques to elucidate the origin of such infections in patients in a California transplantation programme. We tested post-transplant serum from 207 patients who had been HBsAg negative and found 20 to be HBsAg positive. The origin of infection was identified in 7 patients, being occult pre-transplant infection in 5 and occult infection in the donor in 2. No pre-transplant patient nor donor with demonstrable HBV DNA had serological markers of hepatitis B. Post-transplant HBV DNA was present in serum from 19 patients. Analysis of the variable pre-S region of HBV demonstrated 100% sequence homology between recipient liver and post-transplant serum (2 patients) and between donor serum and recipient post-transplant serum (2). There was only 84% homology between the 2 different patients infected with subtype adw. 19 patients are alive, 9 without histological evidence of hepatitis (mean follow-up 33 months), and survival was significantly greater than that of a group with recurrent HBV infection. Apparent acquisition of HBV infection with liver transplantation is not rare, and may be due to occult pre-transplant infection or occult infection in the donor. The post-transplant outcome of this infection tends to be benign but our findings do underscore the clinical relevance of HBV infection in the absence of serological markers.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Base Sequence
  • Blood-Borne Pathogens
  • DNA, Viral / analysis
  • Female
  • Hepatitis B / etiology*
  • Hepatitis B / transmission*
  • Hepatitis B Surface Antigens / analysis
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Liver / microbiology*
  • Liver / pathology
  • Liver Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • San Francisco
  • Tissue Donors*


  • DNA, Viral
  • Hepatitis B Surface Antigens