Characterization of hepatitis B virus surface antigen and polymerase mutations in liver transplant recipients pre- and post-transplant

Jeffrey J. Germer, Michael R. Charlton, Michael B. Ishitani, Curtis D. Forehand, Robin Patel

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


We evaluated serum samples from 18 chronic hepatitis B virus (HBV) patients who underwent liver transplantation for the presence of HBV polymerase and S gene mutations and HBV genotype using a new commercially available sequencing assay. All three patients with hepatitis B immune globulin (HBIG) treatment failure followed by nucleoside analogue treatment failure were infected with HBV genotype C; a pre-existing HBV S antigen (HBsAg) mutation (sD144A) was identified in one patient pretransplant, while sG145R mutations emerged in the other two patients post-transplant. These HBsAg mutations persisted for the duration of the study (5-6 years), despite the absence of HBIG administration for a 4-5-year period. Significant viral polymerase mutations (rtL180M and rtM204I/V) also emerged in all of these patients following treatment with lamivudine and/or famciclovir. Four of six patients with HBIG breakthrough without nucleoside analogue treatment failure yielded potentially significant HBsAg mutations post transplant. These data do not support previous reports highlighting the disappearance of HBsAg mutants in liver transplant recipients after discontinuation of HBIG. Determination of HBV genotype, as well as identification of HBV polymerase and S gene mutations in liver transplant candidates may be warranted to optimize HBV management strategies post transplant.

Original languageEnglish (US)
Pages (from-to)743-753
Number of pages11
JournalAmerican Journal of Transplantation
Issue number6
StatePublished - Jun 2003


  • Adefovir
  • Famciclovir
  • Hepatitis B immune globulin (HBIG)
  • Hepatitis B virus (HBV)
  • Hepatitis B virus surface antigen (HBsAg)
  • Lamivudine
  • Liver transplant
  • Polymerase
  • Surface (S) gene
  • YMDD

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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