title: A YIDD Mutation in a Case of Recurrent Hepatitis B after Liver Transplantation Induced by an S-escape Mutant.
abstract: A 47-year-old woman underwent orthotopic liver transplantation (OLT) for hepatitis B virus (HBV)-related end-stage liver cirrhosis. The patient received hepatitis B immunoglobulin prophylaxis after OLT. Despite the protective level of the serum anti-hepatitis-B surface antibody, HBV recurred at 22 months post-OLT and induced subacute hepatic failure. The pre-OLT HBV genome contained a complex mutation pattern in overlapping frame regions of the surface (S) and polymerase (P) genes, which is the same mutation pattern as seen in post-OLT HBV DNA. G145R and K141R mutations in the "a" determinant were detected only in the post-OLT sample. Clevudine (30 mg once daily) was administered for recurrent hepatitis B. Hepatitis B was reactivated with a flare-up, and a M204I mutation (YIDD mutant type) appeared with a higher viral load at 9 months after clevudine treatment. We report here a case of a YIDD mutation that developed in recurrent hepatitis B after OLT induced by an S-escape mutant.
authors.affiliation: Department of Internal Medicine, Bundang Jesang General Hospital, Daejin Medical Center, Seongnam, Korea.
authors.forename: Yun-Jung
authors.initials: YJ
authors.lastname: Oh
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Park
authors.forename: Sun-Pyo
authors.initials: SP
authors.lastname: Hong
authors.forename: Soo-Kyeong
authors.initials: SK
authors.lastname: Shin
authors.forename: Seung-Il
authors.initials: SI
authors.lastname: Ji
authors.forename: Bo-Hyun
authors.initials: BH
authors.lastname: Kim
authors.forename: Sang-Jong
authors.initials: SJ
authors.lastname: Park
authors.forename: Zheng
authors.initials: Z
authors.lastname: Hong