Fulminant hepatitis B virus: recurrence after liver transplantation in two patients also infected with hepatitis delta virus.
Liver transplantation for hepatitis B virus (HBV)-related liver disease is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV)-related cirrhosis are reported to have a diminished incidence of HBV recurrence and improved graft survival. However, only a few reported HDV-infected patients had active HBV replicative disease before liver transplantation. In our experience, we transplanted two HDV-infected patients, both of whom had active HBV replication before liver transplantation. In one patient, hepatitis B surface antigen (HBsAg) recurred four months after transplantation. Two months later, Hepatitis Be antigen (HBeAg) and HBV-DNA became positive, and the patient died of fulminant recurrent hepatitis B and hepatitis delta. In the other patient, HBV persisted after transplantation, and 2 months later the patient required retransplantation for fulminant recurrent hepatitis B and hepatitis delta. With the second graft, the patient remained free of HBV infection for 1 year. Thereafter, the patient experienced HBV recurrence with active replication and died of fulminant hepatitis B and delta recurrence. In the first case and in the second graft of the second case, hepatitis B immunoglobulin (HBIG) immunoprophylaxis was administered in an attempt to prevent recurrence of HBV. The literature suggests that an HDV infection inhibits the replication of HBV and therefore plays a role in preventing the recurrence of HBV and improving survival. Our experience with two patients suggests that HDV infection, in the presence of active HBV replication, may not play a protective role.
Marsman
W A
WA
Division of Liver Transplantation, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Wiesner
R H
RH
Batts
K P
KP
Poterucha
J J
JJ
Porayko
M K
MK
Niesters
H G
HG
Zondervan
P E
PE
Krom
R A
RA
D000328:Adult; D015897:Comorbidity; D006509:Hepatitis B / Q000453:epidemiology / Q000601:surgery* / Q000821:virology; D003699:Hepatitis D / Q000453:epidemiology / Q000601:surgery* / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D012008:Recurrence