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Clinical reactivation after liver transplantation with an unusual minor strain of hepatitis B virus in an occult carrier
Author(s) -
Zöllner Bernhard,
Feucht HeinzHubert,
Sterneck Martina,
Schäfer Hansjörg,
Rogiers Xavier,
Fischer Lutz
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20858
Subject(s) - medicine , liver transplantation , hbsag , hepatitis b virus , cirrhosis , virology , occult , hepatitis b , serology , transplantation , liver disease , hepatitis , gastroenterology , immunology , virus , pathology , antibody , alternative medicine
Hepatitis B virus (HBV) DNA is detectable in a number of liver transplant candidates who are negative for hepatitis B surface antigen (HBsAg). After liver transplantation (LT), such patients may have molecular and/or serologic evidence of HBV replication. However, clinical disease from reactivation of occult HBV infection after LT has not been described. We report a patient who underwent LT for cryptogenic cirrhosis and had to be retransplanted twice for hepatic artery thrombosis. The patient was negative for HBsAg and positive for anti–hepatitis B core (HBc) and anti‐HBs before all LT procedures and developed acute hepatitis B shortly after receiving the third graft. The HBV strain isolated at that time exhibited an unusual in frame insertion of a CAG motif within the HBV polymerase (HBV INS+ ). HBV INS+ was detected retrospectively as a minor species in pretransplantation sera and the explanted native liver by insertion‐specific polymerase chain reaction. This case in an occult HBV carrier shows that clinically apparent, endogenous reinfection of the graft may occur with minor HBV variants that are not detectable in pretransplantation samples by standard diagnostic procedures. This has implications for the analysis of sources of acute hepatitis B in patients after LT and possibly for consideration of antiviral prophylaxis in anti‐HBc/anti‐HBs/HBV DNA‐positive patients. Liver Transpl 12:1283–1289, 2006. © 2006 AASLD.