title: Course of a HBsAg positive liver transplantation in a hepatitis B and D virus coinfected recipient.
abstract: The increasing demand for transplantation has led to consideration of liver grafts from donors exposed to hepatitis B virus (HBV). Six transplantations of liver grafts from hepatitis B surface antigen (HBsAg) positive donors have been reported; two recipients suffered from HBV/HDV (hepatitis Delta virus) coinfection and were followed up for 10-12 months. Here, we report a 56 months follow-up of a HBV/HDV-coinfected recipient of a HBsAg positive liver graft. Posttransplant combination prophylaxis consisted of hepatitis immunoglobulin, lamivudine and adefovir dipivoxil. HBsAg remained positive during stable posttransplant follow-up and subclinical HDV reinfection with low replication rate was detected at 1 month. Pegylated interferon therapy was introduced after documentation of histological evidence of mild chronic hepatitis, but without virological response after 48 weeks. Finally, antiviral treatment was switched to tenofovir disoproxil fumarate. More than 50 months posttransplant the recipient revealed clinical symptoms of decompensated liver cirrhosis and has been relisted for liver transplantation. In conclusion HBsAg positive liver grafts in HBsAg positive recipients with HDV coinfection may result in virological recurrence and rapid development of liver cirrhosis.
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Muenster, Muenster, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Bahde
authors.forename: Jens P
authors.initials: JP
authors.lastname: Hölzen
authors.forename: Heiner H
authors.initials: HH
authors.lastname: Wolters
authors.forename: Hartmut H J
authors.initials: HH
authors.lastname: Schmidt
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Bock
authors.forename: Andreas
authors.initials: A
authors.lastname: Lügering
authors.forename: Tilmann
authors.initials: T
authors.lastname: Spieker
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Jens G
authors.initials: JG
authors.lastname: Brockmann
mesh_terms: D015897:Comorbidity; D006509:Hepatitis B / Q000601:surgery*; D006514:Hepatitis B Surface Antigens / Q000378:metabolism*; D006515:Hepatitis B virus / Q000302:isolation & purification; D003699:Hepatitis D / Q000601:surgery*; D003698:Hepatitis Delta Virus / Q000302:isolation & purification; D006801:Humans; D008099:Liver / Q000276:immunology* / Q000821:virology; D008103:Liver Cirrhosis / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D006514:Hepatitis B Surface Antigens