Spontaneous resolution of de novo hepatitis B after living donor liver transplantation with hepatitis B core antibody positive graft: a case report

Abstract

BackgroundHepatitis B core antibody (HBcAb)-positive graft is reported to cause de novo hepatitis B after liver transplantation with a probability of 38–100 % without prophylaxis. Hepatitis B surface antigen loss is reported to be achieved with a probability of only 3–8 % in the patients treated by antiviral agents. We present an extremely rare case of spontaneous resolution of de novo hepatitis B after living donor liver transplantation (LDLT) with HBcAb-positive graft.Case presentationAn 8-year-old female patient underwent LDLT for end-stage biliary atresia using an HBcAb-positive left lobe graft. After transplantation, she did not receive any prophylactic agents for hepatitis B. Two years after LDLT, she was diagnosed with chronic hepatitis B. Six years after LDLT, liver fibrosis and hepatitis activity were advanced and lamivudine was started. Two years after lamivudine administration, emergence of a lamivudine-resistant YMDD mutant was detected and adefovir dipivoxil was combined with lamivudine. Hepatitis B virus deoxyribonucleic acid (HBV-DNA) became undetectable soon after the addition of adefovir dipivoxil. Twelve years after transplantation, acute rejection occurred and steroid pulse therapy was performed, but hepatitis B did not become severe and HBV-DNA continued to be undetectable. Fifteen years after LDLT, she voluntarily discontinued medication of all drugs, including immunosuppressive agents and antiviral drugs for 1 year because of mental instability. After an interval of 1 year, liver function was normal and her serological HBV status was as follows: HBsAg(−), HBsAb(+), HBeAb(−), HBeAb(+), HBcAb(+) and HBV-DNA(−). From these results, we diagnosed her condition as spontaneous clearance of de novo hepatitis B. The patient is free of antiviral therapies and continues to take a low dose of immunosuppressive drugs and is leading a normal life.ConclusionsIn this case, HBsAg loss is finally achieved but we need to follow carefully for HBV reactivation with the fibrosis of the graft in mind.

Kushenin combined with adefovir dipivoxil affects the HBV-DNA load in serum, immune functions and liver functions of patients with chronic hepatitis B

“…After the patients in the observation group received the combination treatment of kushenin and adefovir dipivoxil, the HBV-DNA load and TGF-β1 levels were significantly decreased, and the immune function was effectively improved, which may be correlated with the features of oxymatrine, the effective constituent of kushenin, such as the anti-inflammation effect and the capability to eliminate the free radicals ( 16 ), regulate the immune functions of human, stabilize the structure of membrane and induce the activation of enzymatic activity of liver-specific drugs ( 17 ). Combination medication of kushenin and adefovir dipivoxil can remarkably improve the immune functions of patients, and also facilitate the substantial generation of anti-HBV antibodies by B cells ( 18 ), thereby ameliorating the liver function, reducing the level of aminotransferase ( 19 ) and the HBV-DNA load, and increasing the negative-conversion rate of HBeAg.…”

Feasibility of using marginal liver grafts in living donor liver transplantation

“…Moreover, patients who had a YMDD mutation were given adefovir combined with lamivudine[ 123 ]. Hara Y et al[ 127 ] reported one patient who experienced spontaneous eradication of de novo HBV after LDLT with an HBcAb(+) graft without any treatment. This 8-year-old female patient (HBsAg-negative) underwent LDLT, received an HBcAb(+) left-lobe graft, and was subsequently infected with HBV.…”