Fatal Acute Hepatitis B Virus Infection while Receiving Immunosuppressants after Renal Transplantation.

Abstract

A 47-year-old man with acute hepatitis B virus (HBV) infection who had been receiving immunosuppressants after renal transplantation developed progressive liver failure. During the clinical course (approximately 7 months), anti-HBc IgM antibody and HBV-DNApolymerase levels remained high, but the serum alanine aminotransferase (ALT) level was consistently less than 150 K.U. Histopathologic examination of the liver showedsubmassive hepatic necrosis without significant inflammation accompanied by marked fibrosis. Most hepatocytes showed strong nuclear expression ofHBcantigen by immunohistochemicalstaining and electron microscopy revealed numerous intranuclear core-like particles. Hepatitis B virus infection in immunosuppressed individuals occasionally insidiously progresses, resulting in liver failure. The clinical course of such patients thus merits close scrutiny. (Internal Medicine 32: 547-551, 1993)

Acute fulminant hepatitis B in a patient with diabetic nephropathy treated successfully with concomitant lamivudine and molecular adsorbents recirculating system

“…Rapid progression of hepatitis B disease has been reported after liver transplantation 2 and fatal acute hepatitis B virus infection has been reported in patients receiving immunosuppressants after renal transplant. 3 While facing the higher probability of becoming chronic carrier state in immunocompromised/immunosuppressed hosts, patients with rapid progression to FHF should be evaluated for liver transplantation judiciously. Temporary liver support should be also prepared if the donor is not available.…”

Long-Term Outcome of Renal Transplantation in Hepatitis B Surface Antigen-Positive Patients in Cyclosporin Era

“…In addition, Rao et al [9] observed that hepatitis B infection was associated with poor prognosis in renal transplant recipients. Moreover, Hamada et al [10] and Chen et al [11] reported the cases of fatal acute hepatitis and fibrosing cholestasis hepatitis in HBsAg carriers after transplantation.…”

Systematic review of hepatocellular carcinoma mortality rates among hepatitis B virus-infected renal transplant recipients, with supplemental analyses of liver failure and all-cause mortality

“…Two studies reported an absence of an immune response in biopsies of RT patients with acute liver failure. 113,114 Two other studies reported that mononuclear cell infiltrates were predominant. 115,116…”