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

• Published in: Hepatology (Baltimore, Md.) Vol. 25; no. 2; pp. 434 - 438
• Main Authors: Marsman, W A, Wiesner, R H, Batts, K P, Poterucha, J J, Porayko, M K, Niesters, H G, Zondervan, P E, Krom, R A
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.02.1997; Wiley
• Subjects: Adult; Biological and medical sciences; Comorbidity; Hepatitis B - epidemiology; Hepatitis B - surgery; Hepatitis B - virology; Hepatitis D - epidemiology; Hepatitis D - surgery; Hepatitis D - virology; Human viral diseases; Humans; Infectious diseases; Liver Transplantation; Male; Medical sciences; Recurrence; Viral diseases; Viral hepatitis; Human; Postoperative; Relapse; Liver; Hepatic disease; Transplantation; Homotransplantation; Fulminant; Infection; Case study; Viral hepatitis B; Treatment; Surgery; Viral disease; Viral hepatitis delta; Digestive diseases
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.510250230

Liver transplantation for hepatitis B virus (HBV)‐related liver disease is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV)‐ related cirrhosis are reported to have a diminished incidence of HBV recurrence and improved graft survival. However, only a few reported HDV‐infected patients had active HBV replicative disease before liver transplantation. In our experience, we transplanted two HDV‐infected patients, both of whom had active HBV replication before liver transplantation. In one patient, hepatitis B surface antigen (HBsAg) recurred four months after transplantation. Two months later, Hepatitis Be antigen (HBeAg) and HBV‐DNA became positive, and the patient died of fulminant recurrent hepatitis B and hepatitis delta. In the other patient, HBV persisted after transplantation, and 2 months later the patient required retransplantation for fulminant recurrent hepatitis B and hepatitis delta. With the second graft, the patient remained free of HBV infection for 1 year. Thereafter, the patient experienced HBV recurrence with active replication and died of fulminant hepatitis B and delta recurrence. In the first case and in the second graft of the second case, hepatitis B immunoglobulin (HBIG) immunoprophylaxis was administered in an attempt to prevent recurrence of HBV. The literature suggests that an HDV infection inhibits the replication of HBV and therefore plays a role in preventing the recurrence of HBV and improving survival. Our experience with two patients suggests that HDV infection, in the presence of active HBV replication, may not play a protective role.