Fulminant hepatitis B virus: Recurrence after liver transplantation in two patients also infected with hepatitis delta virus

Abstract

sulted in a decrease in HBV recurrence and improved Liver transplantation for hepatitis B virus (HBV)-resurvival after transplantation. 5 However, despite the use of lated liver disease is complicated by HBV recurrence HBIG, patients with active HBV replication still experienced and, consequently, poor patient and graft survival. Paa high recurrence of HBV infection after liver transplantatients transplanted for hepatitis delta virus (HDV)-retion. lated cirrhosis are reported to have a diminished inciAn interesting subgroup of HBV-infected patients are those dence of HBV recurrence and improved graft survival.who are also infected with hepatitis delta virust (HDV). Such However, only a few reported HDV-infected patients had patients are reported to have a decrease in HBV recurrence active HBV replicative disease before liver transplantaand better survival after transplantation. The multicenter tion. In our experience, we transplanted two HDV-instudy in Europe reported 32% HBV recurrence and 85% surfected patients, both of whom had active HBV replicavival rate 3 years after transplantation in patients also intion before liver transplantation. In one patient, fected with HDV. 1 Recently, an HBV recurrence of only 13% hepatitis B surface antigen (HBsAg) recurred four and a 5-year actuarial survival rate of 88% was reported for months after transplantation. Two months later, Hepatiliver transplantation in patients with HDV infection. 6 All tis Be antigen (HBeAg) and HBV-DNA became positive, patients were also negative for HBV-DNA at the time of and the patient died of fulminant recurrent hepatitis B transplant. It has been suggested that suppressed HBV repliand hepatitis delta. In the other patient, HBV persisted cation in patients with HDV infection plays a role in the after transplantation, and 2 months later the patient rediminished recurrence of HBV. Indeed, the number of HDVquired retransplantation for fulminant recurrent hepainfected patients who had active replication of HBV before titis B and hepatitis delta. With the second graft, the transplantation was quite small. 6 patient remained free of HBV infection for 1 year. ThereThe outcome of patients with HDV infection who have acafter, the patient experienced HBV recurrence with active HBV replication remains undefined. Therefore, we report tive replication and died of fulminant hepatitis B and the clinical course of the only two HDV-infected patients who delta recurrence. In the first case and in the second graft underwent liver transplantation at our center. Both patients of the second case, hepatitis B immunoglobulin (HBIG) had active HBV replication before transplantation, noted by immunoprophylaxis was administered in an attempt to the presence of both hepatitis-Be-antigen (HBeAg) and HBVprevent recurrence of HBV. The literature suggests that DNA. Three liver transplantations were performed in these an HDV infection inhibits the replication of HBV and two patients, and both died because of fulminant recurrence therefore plays a role in preventing the rec...

Occult hepatitis B virus infection and its clinical implications

“…HBV‐DNA sequencing of partial or whole HBV genome from patients with FHB showed variable mutations, but failed to confirm a distinct one specifically associated with FHB [111–113]. On the other hand, coinfection of other hepatitis viruses appears a common phenomenon in these patients [114–116].…”

Acute liver failure: Established and putative hepatitis viruses and therapeutic implications

“…This presumably relates to the high prevalence of viral clearance prior to the procedure in the former setting. Reports are conflicting as to whether co‐infection with HDV favours a reduced incidence of hepatitis B recurrence following OLT, consequent to an inhibitory effect on HBV replication 88–91 . In patients in whom viral eradication is not attained pre‐OLT, infection with the precore mutant HBV strain may be associated with more severe post‐OLT disease, with a substantially increased risk of HBV‐related graft loss compared with that associated with wild‐type infection reported in one study 92 .…”

Prophylaxis and treatment of hepatitis B infection in the setting of liver transplantation

“…In the early '90, a multicenter European study showed a 32% recurrence rate among HBV-hepatitis D virus (HDV) coinfected patients compared to 53% in patients with HBV infection alone (6). The protective role of HDV infection has been shown only in liver cirrhosis, but not in acute hepatitis B, and it is supposed to be related to the inhibition of HBV replication (7).…”