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Fung et al. Hepatoma Res 2018;4:62 Hepatoma Research
DOI: 10.20517/2394-5079.2018.92

Original Article Open Access

Quantitative hepatitis B surface antigen in predicting
recurrence of hepatitis B-related hepatocellular
carcinoma after liver transplantation

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James Fung 1,2,3 , Danny Ka-Ho Wong , Yasuhito Tanaka , Regina Lo , Tiffany Wong , Kenneth Siu-Ho
Chok , Albert Chi-Yan Chan , Tan-To Cheung , Wing-Chiu Dai , Kelvin Ng , Kevin Ng , Man Kwan ,
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Irene Ng , Wai-Kay Seto , Ching-Lung Lai , Man-Fung Yuen , Chung-Mau Lo 1,3,6
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1 The Liver Transplant Center, Queen Mary Hospital, Hong Kong, China.
2 Department of Medicine, the University of Hong Kong, Hong Kong, China.
3 State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China.
4 Department of Virology and Liver Unit, Graduate School of Medical sciences, Nagoya City University, Nagoya 467-8601, Japan.
5 Department of Pathology, the University of Hong Kong, Hong Kong, China.
6 Department of Surgery, the University of Hong Kong, Hong Kong, China.
Correspondence to: Dr. James Fung, the Liver Transplant Center, Queen Mary Hospital, Hong Kong, China. E-mail: jfung@gastro.hk
How to cite this article: Fung J, Wong DKH, Tanaka Y, Lo R, Wong T, Chok KSH, Chan ACY, Cheung TT, Dai WC, Ng K, Ng K, Kwan
M, Ng I, Seto WK, Lai CL, Yuen MF, Lo CM. Quantitative hepatitis B surface antigen in predicting recurrence of hepatitis B-related
hepatocellular carcinoma after liver transplantation. Hepatoma Res 2018;4:62. http://dx.doi.org/10.20517/2394-5079.2018.92
Received: 26 Jul 2018 First Decision: 9 Aug 2018 Revised: 30 Aug 2018 Accepted: 30 Aug 2018 Published: 29 Sep 2018
Science Editor: Guang-Wen Cao Copy Editor: Yuan-Li Wang Production Editor: Zhong-Yu Guo
Abstract
Aim: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for chronic hepatitis B (CHB)
can be associated with reappearance of hepatitis B surface antigen (HBsAg). The current study determined
the significance of HBsAg qualitatively and quantitatively using a highly sensitive assay in recurrent HCC after
transplantation.

Methods: Consecutive patients with HBV-related HCC with LT were included. Oral nucleos(t)ide analogues
without hepatitis B immune globulin were used as hepatitis B virus (HBV) prophylaxis. Quantitative HBsAg levels
were performed at time of transplant, at 1 month, 3 and 6 months post transplant using a highly sensitive (hs)-
HBsAg assay.

Results: One hundred and fourteen patients were included, with a median follow-up of 80 months, with 24
cases of HCC recurrence, and a cumulative rate of 20.7% at 5 years. There was significant correlation between
time of tumor recurrence and time of HBsAg reappearance (r = 0.551, P = 0.027). Early HCC recurrence was
associated with higher median level of hs-HBsAg at the time of transplant (72.85 vs. 69.70 IU/mL, P = 0.018).
Using a hs-HBsAg cut-off level of 0.0005 IU/mL, patients with levels above this threshold at 3 and 6 months were

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