De novo acute hepatitis B infection in a previously vaccinated liver transplant recipient due to a strain of HBV with a Met 133 Thr mutation in the “a” determinant

: De novo HBV infection post‐liver transplantation (LT) from an anti‐HBc seropositive donor rarely presents as acute failure. We report a 42‐year‐old Caucasian female, HBsAg and anti‐HBc seronegative, with primary biliary cirrhosis who received an allograft from a HBsAg negative, anti‐HBc seropositi...

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Bibliographic Details
Published in:Liver (Copenhagen) 2000-10, Vol.20 (5), p.411-414
Main Authors: Yoshida, Eric M., Ramji, Alnoor, Erb, Siegfried R., Davis, Jennifer E., Steinbrecher, Urs P., Sherlock, Christopher H., Scudamore, Charles H., Chung, Stephen W., Williams, Mark, Gutfreund, Klaus S.
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Amino Acid Substitution - genetics
Biological and medical sciences
de novo
Female
hepatitis B
Hepatitis B - immunology
Hepatitis B - pathology
Hepatitis B - virology
Hepatitis B Surface Antigens - genetics
Hepatitis B Surface Antigens - immunology
Hepatitis B Vaccines - immunology
Hepatitis B virus - genetics
Hepatitis B virus - immunology
Hepatitis B virus - physiology
Hepatocytes - pathology
Hepatocytes - virology
Histocytochemistry
Human viral diseases
Humans
Infectious diseases
liver
Liver - pathology
Liver - virology
Liver Cirrhosis, Biliary - surgery
Liver Transplantation - immunology
Medical sciences
mutant
Mutation - genetics
RNA, Viral - blood
Sequence Analysis, DNA
surface antigen
Tissue Donors
transplantation
Vaccination
Viral diseases
Viral hepatitis
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Summary:: De novo HBV infection post‐liver transplantation (LT) from an anti‐HBc seropositive donor rarely presents as acute failure. We report a 42‐year‐old Caucasian female, HBsAg and anti‐HBc seronegative, with primary biliary cirrhosis who received an allograft from a HBsAg negative, anti‐HBc seropositive donor. The patient, previously vaccinated years pre‐LT, was re‐vaccinated against HBV and 1 year post‐LT had an anti‐HBs titre of 256 IU/l. Two years post‐LT, elevated serum aminotransferases and worsening liver function with an INR of 2.0 developed. The HBsAg became positive, anti‐HBs undetectable and serum HBV‐DNA >2000 pg/ml by hybridisation assay. Liver biopsy revealed significant ballooning degeneration, piecemeal necrosis and positive immunostaining for HBsAg. Progressive liver failure developed followed by sepsis and terminal multi‐organ failure. Subsequent analysis of the predominant HBV strain revealed mutations in the “a” determinant: Met 133 Thr (codon change ATG to ACG) and Asn 131 Thr. Conclusion: Acute de novo HBV infection from an anti‐HBc sero‐positive donor may occur long after LT despite protective anti‐HBs titres post‐vaccination secondary to the emergence of “a” determinant mutated strains of HBV.
ISSN:0106-9543
1600-0676
DOI:10.1034/j.1600-0676.2000.020005411.x