Case report of lamivudine-resistant hepatitis B virus infection post liver transplantation from a hepatitis B core antibody donor

R. D. Yen, H. Bonatti, J. Mendez, J. Aranda-Michel, R. Satyanarayana, R. C. Dickson

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

The use of allografts from donors with hepatitis B core antibody in liver transplantation (LT) is associated with the risk of de novo hepatitis B virus (HBV) infection. Prophylaxis using hepatitis B Immune globulin (HBIg) and lamivudine alone or in combination has been reported. Yet, there are no standardized regimens and long-term efficacy is not known. We report a case of a patient who underwent LT for alcoholic liver disease who received an allograft from a donor with Hepatitis B core antibody. The patient had no previous exposure to HBV, was vaccinated against HBV, and had demonstrated Hepatitis B surface antibody present in serum before and 6 months after transplantation. Prophylaxis with short-term HBIg (1 week) and indefinite lamivudine was given. De novo HBV infection developed more than 3 years after LT with a lamivudine-resistant polymerase mutant containing the rtM204I and rtl180L/M mutations. We reviewed the risk of de novo post-LT HBV infection in recipients of livers from hepatitis B core antibody positive donors. High risk were HBV naïve recipients, moderate risk recipients had isolated hepatitis B surface antibody (anti-HBs) or hepatitis B core antibody (anti-HBc), while low-risk recipients had both anti-HBs and anti-HBc. We reviewed prophylaxis protocols reported in the literature and made recommendations for management.

Original languageEnglish (US)
Pages (from-to)1077-1083
Number of pages7
JournalAmerican Journal of Transplantation
Volume6
Issue number5 I
DOIs
StatePublished - May 1 2006

Keywords

  • Adefovir
  • Hepatitis B immune globulin
  • Prophylaxis
  • YMDD mutation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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