De novo acute hepatitis B infection in a previously vaccinated liver transplant recipient due to a strain of HBV with a Met 133 Thr mutation in the "a" determinant.
De novo HBV infection post-liver transplantation (LT) from an anti-HBc seropositive donor rarely presents as acute failure. We report a 42-year-old Caucasian female, HBsAg and anti-HBc seronegative, with primary biliary cirrhosis who received an allograft from a HBsAg negative, anti-HBc seropositive donor. The patient, previously vaccinated years pre-LT, was re-vaccinated against HBV and 1 year post-LT had an anti-HBs titre of 256 IU/l. Two years post-LT, elevated serum aminotransferases and worsening liver function with an INR of 2.0 developed. The HBsAg became positive, anti-HBs undetectable and serum HBV-DNA >2000 pg/ml by hybridisation assay. Liver biopsy revealed significant ballooning degeneration, piecemeal necrosis and positive immunostaining for HBsAg. Progressive liver failure developed followed by sepsis and terminal multi-organ failure. Subsequent analysis of the predominant HBV strain revealed mutations in the "a" determinant: Met 133 Thr (codon change ATG to ACG) and Asn 131 Thr.


CONCLUSIONS
' Acute de novo HBV infection from an anti-HBc sero-positive donor may occur long after LT despite protective anti-HBs titres post-vaccination secondary to the emergence of "a" determinant mutated strains of HBV.
Yoshida
E M
EM
British Columbia Transplant Society and the Department of Medicine, University of British Columbia, Vancouver, Canada.
Ramji
A
A
Erb
S R
SR
Davis
J E
JE
Steinbrecher
U P
UP
Sherlock
C H
CH
Scudamore
C H
CH
Chung
S W
SW
Williams
M
M
Gutfreund
K S
KS
D000208:Acute Disease; D000328:Adult; D019943:Amino Acid Substitution / Q000235:genetics*; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000473:pathology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000235:genetics* / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000502:physiology*; D022781:Hepatocytes / Q000473:pathology / Q000821:virology; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008105:Liver Cirrhosis, Biliary / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology; D009154:Mutation / Q000235:genetics; D012367:RNA, Viral / Q000097:blood; D017422:Sequence Analysis, DNA; D014019:Tissue Donors; D014611:Vaccination
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D012367:RNA, Viral