Gut Liver.  2011 Jun;5(2):248-252.

De Novo Superinfection of Hepatitis B Virus in an Anti-HBs Positive Patient with Recurrent Hepatitis C Following Liver Transplantation

• Ha SH
• Park YM
• Hong SP
• Back SY
• Shin SK
• Ji SI
• Kim SO
• Yoo WD
• Kim BH
• Park SJ
• Hong Z

Abstract

A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post-OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM anti-hepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1x10(7) copies/mL. A sequencing analysis showed no mutation in the "a" determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.

Keyword

De novo hepatitis B virus infection; Occult hepatitis B virus infection; Post-orthotopic liver transplantation recurrent hepatitis C; Orthotopic liver transplantation

MeSH Terms

Antibodies
Biopsy
Codon
DNA
Female
Genotype
Hepacivirus
Hepatitis
Hepatitis B
Hepatitis B e Antigens
Hepatitis B Surface Antigens
Hepatitis B virus
Hepatitis C
Hepatocytes
Humans
Immunoglobulin M
Interferon-alpha
Liver
Liver Cirrhosis
Liver Transplantation
Middle Aged
Ribavirin
Superinfection
Viruses
Antibodies
Codon
DNA
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Immunoglobulin M
Interferon-alpha
Ribavirin