Postoperative hepatitis B virus reactivation and surgery-induced immunosuppression in patients with hepatitis B-related hepatocellular carcinoma

BackgroundHepatectomy in hepatocellular carcinoma (HCC) patients lead to postoperative hepatitis B virus (HBV) reactivation (PHR) as well as immunosuppression. MethodsThis prospective study involved 135 HBV-related HCC patients and 42 control hepatic hemangioma patients. ResultsAmong HCC patients, 26 (19.3%) suffered PHR. Risk factors for PHR were HBV-cAg S1 positivity [hazard ratio (HR)=404.82, P=0.004], high preoperative total bilirubin level (HR=186.38, P=0.036), small preoperative proportions of CD3-CD16+CD56+cells (HR=0.01, P=0.014) and CD19+B cells (HR=0.02, P=0.016), blood transfusion (HR=157.03, P=0.006) and high liver cirrhosis S score (HR=270.45, P=0.004). On postoperative day (POD) 3, PHR patients showed much greater immunosuppression than non-PHR patients based on proportions of T cells (CD3+, CD3+CD4+, CD3+CD8+), B cells (CD19+) and on levels of IgG, IgA antibodies, complement proteins C3, and C4. By POD 7, PHR patients had partially recovered but not as quickly as non-PHR patients: PHR patients still showed deficits in T cells (CD3+, CD3+CD4+), CD3-CD16+CD56+ cells and in levels of IgM, C3, C4, and C-reactive protein. ConclusionPHR may be associated with resection-induced immunosuppression in patients with HBV-related HCC. J. Surg. Oncol. 2015;112:634-642. (c) 2015 Wiley Periodicals, Inc.