Clinical reactivation after liver transplantation with an unusual minor strain of hepatitis B virus in an occult carrier.
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Clinical reactivation after liver transplantation with an unusual minor strain of hepatitis B virus in an occult carrier. / Zöllner, Bernhard; Feucht, Heinz Hubert; Sterneck, Martina; Schäfer, Hansjörg; Rogiers, Xavier; Fischer, Lutz.
in: LIVER TRANSPLANT, Jahrgang 12, Nr. 8, 8, 2006, S. 1283-1289.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical reactivation after liver transplantation with an unusual minor strain of hepatitis B virus in an occult carrier.
AU - Zöllner, Bernhard
AU - Feucht, Heinz Hubert
AU - Sterneck, Martina
AU - Schäfer, Hansjörg
AU - Rogiers, Xavier
AU - Fischer, Lutz
PY - 2006
Y1 - 2006
N2 - Hepatitis B virus (HBV) DNA is detectable in a number of liver transplant candidates who are negative for hepatitis B surface antigen (HBsAg). After liver transplantation (LT), such patients may have molecular and/or serologic evidence of HBV replication. However, clinical disease from reactivation of occult HBV infection after LT has not been described. We report a patient who underwent LT for cryptogenic cirrhosis and had to be retransplanted twice for hepatic artery thrombosis. The patient was negative for HBsAg and positive for anti-hepatitis B core (HBc) and anti-HBs before all LT procedures and developed acute hepatitis B shortly after receiving the third graft. The HBV strain isolated at that time exhibited an unusual in frame insertion of a CAG motif within the HBV polymerase (HBV(INS+)). HBV(INS+) was detected retrospectively as a minor species in pretransplantation sera and the explanted native liver by insertion-specific polymerase chain reaction. This case in an occult HBV carrier shows that clinically apparent, endogenous reinfection of the graft may occur with minor HBV variants that are not detectable in pretransplantation samples by standard diagnostic procedures. This has implications for the analysis of sources of acute hepatitis B in patients after LT and possibly for consideration of antiviral prophylaxis in anti-HBc/anti-HBs/HBV DNA-positive patients.
AB - Hepatitis B virus (HBV) DNA is detectable in a number of liver transplant candidates who are negative for hepatitis B surface antigen (HBsAg). After liver transplantation (LT), such patients may have molecular and/or serologic evidence of HBV replication. However, clinical disease from reactivation of occult HBV infection after LT has not been described. We report a patient who underwent LT for cryptogenic cirrhosis and had to be retransplanted twice for hepatic artery thrombosis. The patient was negative for HBsAg and positive for anti-hepatitis B core (HBc) and anti-HBs before all LT procedures and developed acute hepatitis B shortly after receiving the third graft. The HBV strain isolated at that time exhibited an unusual in frame insertion of a CAG motif within the HBV polymerase (HBV(INS+)). HBV(INS+) was detected retrospectively as a minor species in pretransplantation sera and the explanted native liver by insertion-specific polymerase chain reaction. This case in an occult HBV carrier shows that clinically apparent, endogenous reinfection of the graft may occur with minor HBV variants that are not detectable in pretransplantation samples by standard diagnostic procedures. This has implications for the analysis of sources of acute hepatitis B in patients after LT and possibly for consideration of antiviral prophylaxis in anti-HBc/anti-HBs/HBV DNA-positive patients.
M3 - SCORING: Zeitschriftenaufsatz
VL - 12
SP - 1283
EP - 1289
JO - LIVER TRANSPLANT
JF - LIVER TRANSPLANT
SN - 1527-6465
IS - 8
M1 - 8
ER -
