{"doi":"10.1111/liv.70175","title":"Hepatitis B Virus Variants and Cytokine Patterns in Acute Liver Failure and Transplant‐Free Survival","abstract":"ABSTRACT Background & Aims Only 25% of hepatitis B‐related acute liver failure (HBV‐ALF) patients survive without liver transplantation (transplant‐free survival, TFS). There is limited study of immunological and virological profiles in these patients. We analysed the association between hepatitis B viremia and cytokine patterns on TFS of HBV‐ALF patients. Methods We identified 48 acute and 20 history of HBV infection ALF patients from the US ALF Study Group registry (> 3400 patients). The inclusion criteria were age > 18 years, diagnosis of HBV‐ALF with hepatic encephalopathy and INR ≥ 1.5. Data were collected from ICU admission through day 21. Serum collected at admission and at days 3–5 were used for cytokine quantification by Luminex and novel HBV biomarkers, genotypes and variants. Results In 48 acute (50% F, median age 40 years) and 20 history/reactivation (40% F, median age 53 years) HBV‐ALF patients, there were 26 (54%) and 5 (25%) TFS, respectively. Detectable HBV DNA by clinical PCR assay (median 3.39 log 10 IU/mL, aOR 5.308; 95% CI: 1.217–23.155, p = 0.026) and qAHBc levels (median 4.5 log 10 IU/mL, aOR 4.466, 95% CI: 0.968–20.608, p = 0.050) were associated with TFS in acute HBV‐ALF patients. HBV variants associated with anti‐viral immune escape were more frequently detected in acute HBV‐ALF TFS patients compared to non‐TFS ( p < 0.05). TFS with acute HBV‐ALF had higher angiogenic factors (PDGF‐AA, p = 0.008; PDGF‐BB, p = 0.0006; VEGF‐A, p = 0.014) and lower pro‐inflammatory cytokine levels (IL‐1α, p = 0.031; IL‐2, p = 0.014; IL‐6, p = 0.039). Significant differences in HBV viremia were not observed in history/reactivation of HBV‐ALF patients. Conclusions Acute HBV‐ALF patients with TFS were often viremic with immune escape variants, increased angiogenic factors and decreased pro‐inflammatory cytokines. Trial Registration: ClinicalTrials.gov identifier: NCT00518440","journal":"Liver International","year":2025,"id":516264,"datarank":0.7380271269753924,"base_score":2.3978952727983707,"endowment":2.3978952727983707,"self_citation_contribution":0.3596842909197557,"citation_network_contribution":0.3783428360556368,"self_endowment_contribution":0.3596842909197557,"citer_contribution":0.3783428360556368,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":7,"citers_with_citation_signal":3,"citers_with_endowment":3,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8327,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT00518440"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1381627,"name":"Annie Y. Chen","orcid":"0000-0002-3730-162X","position":1,"is_corresponding":false},{"id":570340,"name":"Carla Osiowy","orcid":"0000-0002-5429-7220","position":2,"is_corresponding":false},{"id":1382093,"name":"Valerie Durkalski Mauldin","orcid":null,"position":3,"is_corresponding":false},{"id":337973,"name":"William M. Lee","orcid":"0000-0002-2783-5441","position":4,"is_corresponding":false},{"id":1020266,"name":"Carla S. Coffin","orcid":"0000-0002-1472-0901","position":5,"is_corresponding":false},{"id":337974,"name":"Constantine Karvellas","orcid":"0000-0002-1555-1089","position":6,"is_corresponding":false},{"id":1277915,"name":"the US Acute Liver Failure Study Group","orcid":null,"position":7,"is_corresponding":false},{"id":1272095,"name":"Nishi Patel","orcid":"0000-0002-1869-1773","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:48:49.486328Z","pmid":"40540404","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}