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Renal transplantation from hepatitis B surface antigen ( HB sAg)‐positive donors to HB sAg‐negative recipients: a case of post‐transplant fulminant hepatitis associated with an extensively mutated hepatitis B virus strain and review of the current literature
Author(s) -
Magiorkinis E.,
Paraskevis D.,
Pavlopoulou I.D.,
Kantzanou M.,
Haida C.,
Hatzakis A.,
Boletis I.N.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12094
Subject(s) - medicine , fulminant hepatitis , hepatitis b virus , virology , hbsag , hepatitis b , transplantation , immunology , fulminant , virus
Purpose The purpose of this study was to present a fatal case of fulminant hepatitis B ( FHB ) that developed in a renal transplant recipient, immunized against hepatitis B, 1 year post transplantation. Methods Polymerase chain reaction amplification and full genome sequencing were performed to investigate whether specific mutations were associated with hepatitis B virus ( HBV ) transmission and FHB . Results Molecular analysis revealed multiple mutations in various open reading frames of HBV , the most important being the G145R escape mutation and a frameshift mutation–insertion (1838insA) within the pre‐C/C reading frame. Conclusions Our results highlight the possibility of developing FHB , despite previous immunization against HBV or administration of hyperimmune gammaglobulin, because of the selection of escape virus mutants. The current literature and guidelines regarding renal transplantation from hepatitis B surface antigen ( HB sAg)‐positive to HB sAg‐negative patients were also reviewed.