title: Hepatitis B reactivation in a renal transplant patient due to a surface antigen mutant strain: a case report.
abstract: BACKGROUND
  Reactivation of hepatitis B virus (HBV) is a complication of immunosuppressive treatment in patients with a history of HBV exposure.
  
  
  METHODS
  Herein we have reported a case of reactivation after renal transplantation in a 52-year-old male chronic HBV carrier who was treated with hepatitis B immunoglobulin (HBIg) prophylaxis immediately after transplantation in addition to cyclosporine, mycophenolate mofetil and prednisolone for maintenance immunosuppression. After application of rituximab, the patient developed clinical hepatitis with a high load of HBV DNA. Sequence analysis of the surface (S) antigen corresponding to the amino acid residues 101-186 (including the a-determinant region) revealed a genotype D mutant strain, subtype ayw3 with a single amino acid substitution D144E within the S gene.
  
  
  CONCLUSIONS
  This case suggested that immunosuppressive treatment enhanced with rituximab promoted the emergence of an HBV mutant within the determinant region of the S antigen, which escaped HBIg immunoprophylaxis causing HBV reactivation in a kidney transplant recipient.
authors.affiliation: Department of Immunology, Hippokration General Hospital, Thessaloniki, Greece. iosfyl@otenet.gr
authors.forename: A
authors.initials: A
authors.lastname: Fylaktou
authors.forename: M
authors.initials: M
authors.lastname: Daoudaki
authors.forename: V
authors.initials: V
authors.lastname: Dimou
authors.forename: E
authors.initials: E
authors.lastname: Sianou
authors.forename: D
authors.initials: D
authors.lastname: Papaventsis
authors.forename: I
authors.initials: I
authors.lastname: Mavrovouniotis
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D001483:Base Sequence; D015415:Biomarkers / Q000097:blood; D016572:Cyclosporine / Q000009:adverse effects; D004252:DNA Mutational Analysis; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination; D006514:Hepatitis B Surface Antigens / Q000235:genetics*; D006515:Hepatitis B virus / Q000235:genetics* / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000517:prevention & control / Q000821:virology*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D011239:Prednisolone / Q000009:adverse effects; D000069283:Rituximab; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D000069283:Rituximab; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; C045213:hepatitis B hyperimmune globulin