Patient with hepatitis B and alcoholic liver disease before and after liver transplantation.
We present the case of a patient with hepatitis B virus infection and alcohol use (30 g/day by self-report) who developed cirrhosis and proceeded to liver transplantation at age 49. The explanted liver showed cirrhosis with evidence of burnt-out steatohepatitis and hepatitis B virus and a 0.7-cm focus of well-differentiated hepatocellular carcinoma. He was managed following transplant with tacrolimus, prednisone, lamivudine, adefovir, and hepatitis B immune globulin infusions. His post-transplant course was complicated by several episodes of elevated liver enzymes. Liver biopsy 3 months after liver transplantation showed acute rejection and mild steatohepatitis. Liver biopsy 6 months after liver transplantation showed marked steatosis (approximately 95%) with moderate steatohepatitis and evidence of treated rejection. Subsequent biopsies (15 and 21 months post liver transplantation) showed resolution of the steatohepatitis, but development of chronic rejection. We discuss the interaction of alcoholic liver disease and hepatitis B virus in the development of cirrhosis and hepatocellular carcinoma, as well as the role of liver transplantation in these patients.
Ward
Stephen C
SC
The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York 10029, USA. Stephen.Ward@mssm.edu
Chang
Charissa Y
CY
Peng
Lan
L
Liu
Lawrence U
LU
D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery; D005234:Fatty Liver / Q000209:etiology / Q000601:surgery; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008108:Liver Diseases, Alcoholic / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents