title: Rapid early HDV RNA decline in the peripheral blood but prolonged intrahepatic hepatitis delta antigen persistence after liver transplantation.
abstract: OBJECTIVE
  Chronic HDV infection is an inflammatory liver disease and liver transplantation (LTX) remains the only curative treatment option for most patients. The hepatitis D virus (HDV) uses HBsAg as its surface protein, however, it is controversial to what extend HDV may be detected independently of HBsAg in blood and liver after LTX. The aims of this study were to investigate kinetics of HDV RNA and HBsAg early after LTX, to apply the data to a mathematical model and to study long-term persistence of HDV after LTX.
  
  
  METHODS
  We retrospectively analyzed 26 patients with chronic hepatitis delta who underwent LTX between 1994 and 2009. Blood samples were obtained every 1-3 days during the first 14 days after LTX. Data were applied to a mathematical model to study viral kinetics. Available liver biopsy samples were stained for HBV and HDV viral antigens and tested for HBV DNA/cccDNA.
  
  
  RESULTS
  HBsAg and HDV RNA became negative after a median of 5 days (range 1-13) and 4 days (range 1-10), respectively. Early HDV RNA and HBsAg decline paralleled almost exactly in all patients; however the mathematical model showed a high variability of virion death. HDAg stained positive in transplanted livers in six patients in the absence of liver HBV DNA/cccDNA, serum-HBsAg, and HDV RNA for up to 19 months after LTX.
  
  
  CONCLUSIONS
  HDV RNA and HBsAg decline follow almost identical kinetic patterns within the first days after LTX. Nevertheless, intrahepatic latency of HDAg has to be considered when exploring novel concepts to withdraw HBIG.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Mederacke
authors.forename: Natalie
authors.initials: N
authors.lastname: Filmann
authors.forename: Cihan
authors.initials: C
authors.lastname: Yurdaydin
authors.forename: Birgit
authors.initials: B
authors.lastname: Bremer
authors.forename: Florian
authors.initials: F
authors.lastname: Puls
authors.forename: Behrend Johann
authors.initials: BJ
authors.lastname: Zacher
authors.forename: Benjamin
authors.initials: B
authors.lastname: Heidrich
authors.forename: Hans Ludger
authors.initials: HL
authors.lastname: Tillmann
authors.forename: Jens
authors.initials: J
authors.lastname: Rosenau
authors.forename: C-Thomas
authors.initials: CT
authors.lastname: Bock
authors.forename: Berna
authors.initials: B
authors.lastname: Savas
authors.forename: Fabian
authors.initials: F
authors.lastname: Helfritz
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: Juergen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Karsten
authors.initials: K
authors.lastname: Wursthorn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lehmann
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
mesh_terms: D000328:Adult; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019701:Hepatitis D, Chronic / Q000601:surgery* / Q000821:virology*; D003698:Hepatitis Delta Virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D035923:Hepatitis delta Antigens / Q000032:analysis; D006801:Humans; D008099:Liver / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D012189:Retrospective Studies; D013997:Time Factors; D017735:Virus Latency; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens; D035923:Hepatitis delta Antigens; D012367:RNA, Viral