Acutely exaggerated hepatitis B induced by the withdrawal of immunosuppressants in a seroconverted renal transplant recipient: report of a case.
The long-term reciprocal impact of renal transplantation on infection by hepatitis B virus (HBV) is still a matter of intense debate, and the topic remains controversial. We herein report the case of a 50-year-old male asymptomatic HBV carrier who had seroconverted to positive anti-HBe antibody (Ab) and received a kidney transplantation from a cadaver donor (HB surface(s) antigen (Ag)-negative). Nine months later, his kidney function deteriorated due to chronic rejection, and hemodialysis was temporarily required. Triple drug therapy (cyclosporine, prednisolone, azathioprine) for immunosuppression was changed to two-drug therapy (cyclosporine and prednisolone) at a reduced dosage because of this episode. After that episode, severe hepatitis with HBV antigenemia developed without any change in the serological state. The levels of DNA polymerase in a potential recipient from a cadaveric donor should be checked before transplantation to predict the occurrence of hepatitis when the recipient is an asymptomatic carrier of HBV, especially in cases of serologically HBeAg-negative, and anti-HBeAb-positive carriers.
Gunji
Yoshio
Y
Department of Academic Surgery, Graduate School of Medicine, Chiba University, Japan.
Sakamoto
Kaoru
K
Sato
Shinichi
S
Hamaguchi
Kinichi
K
Kamura
Kouichi
K
Yamada
Kenichi
K
Arita
Seiji
S
Kashiwabara
Hidehiko
H
Hori
Seiji
S
Shimada
Hideaki
H
Suzuki
Takao
T
Ochiai
Takenori
T
D000208:Acute Disease; D002353:Carrier State / Q000276:immunology; D006509:Hepatitis B / Q000175:diagnosis / Q000209:etiology / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged
D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens; D007166:Immunosuppressive Agents