Dual hepatitis virus infections in liver transplant: case report and a review of the literature.
BACKGROUND
Liver transplantation (LT) using grafts from anti-HBVcore antibody-positive (anti-HBVcAB+) donors carry risk for development of hepatitis B virus (HBV) infection. The long-term course of hepatitis C virus (HCV) patients receiving anti-HBVcAB+ grafts is poorly understood.


METHODS
A patient with chronic hepatitis C received an anti-HBVc+ graft and developed de novo hepatitis B after four months. We describe the 14 HCV patients who received antiHBVc+ grafts and the condition of disease.


RESULTS
Hepatitis B was treated successfully with lamivudine. One year later, breakthrough infection developed with a lamivudine-resistant mutant. Addition of adefovir led to HBV surface antigen to surface antibody seroconversion after two yr, which was maintained long term. Antiviral therapy was discontinued. Liver biopsy revealed minimal histologic changes up to eight yr post-LT. Survival of 14 recipients of antiHBVc+ allografts and 180 recipients of antiHBVc-negative grafts was equal (minimum follow up of five yr). Liver biopsies at four yr showed grade 0/1 and stage 0/1 in >70%; only two patients showed bridging fibrosis. A literature review of dual hepatitis virus infection revealed an overall milder course of hepatitis post-LT.


CONCLUSIONS
The outcome of HCV patients receiving anti-HBc+ grafts is good and may be associated with a milder course of recurrent HCV.
Yataco
Maria L
ML
Division of Hepatology and Gastroenterology, Mayo Clinic, Jacksonville, FL 32216, USA.
Dickson
Rolland C
RC
Bonatti
Hugo
H
Aranda-Michel
Jaime
J
Mendez
Julio
J
Ghabril
Marwan
M
Nguyen
Justin
J
D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D016174:Hepacivirus / Q000276:immunology; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology; D006526:Hepatitis C / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation; D008875:Middle Aged
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D019259:Lamivudine