Recurrence of clinically significant hepatitis A following liver transplantation for fulminant hepatitis A

Hepatitis A: Clinical Manifestations and Management

“…Results from one study showed that among 35 cases of fulminant hepatitis, 57% survived without LT, 6% died without LT, 29% survived after LT and 9% died after LT. By multiple logistic regression analysis, the independent prognostic factor for spontaneous survival was the degree of hepatic encephalopathy [16] . An interesting case of recurrent hepatitis A after LT for fulminant hepatitis A in transplanted liver has been reported [17] .…”

Histopathological Syndromes of Liver Allograft Rejection and Recurrent Disease

“…Biopsy findings showed changes generally attributable to hepatitis: variable hepatocyte apoptosis, degenerative changes of hepatocytes with cholestasis, mild portal inflammation with variable bile duct damage, and ductular cholestasis [188,189]. However, HAV RNA can be detected in liver tissue of patients with otherwise typical acute or chronic rejection [188][189][190][191].…”

“…Hepatitis A Several case reports show that hepatitis A virus (HAV) can persist or recur after transplantation, as determined by detection of genomic HAV RNA by reverse transcription polymerase chain reaction (RT-PCR) in liver tissue, serum, and stool at the time of transient graft dysfunction and in one case of apparent HAVinduced allograft failure [188,189]. Biopsy findings showed changes generally attributable to hepatitis: variable hepatocyte apoptosis, degenerative changes of hepatocytes with cholestasis, mild portal inflammation with variable bile duct damage, and ductular cholestasis [188,189].…”

“…Biopsy findings showed changes generally attributable to hepatitis: variable hepatocyte apoptosis, degenerative changes of hepatocytes with cholestasis, mild portal inflammation with variable bile duct damage, and ductular cholestasis [188,189]. However, HAV RNA can be detected in liver tissue of patients with otherwise typical acute or chronic rejection [188][189][190][191]. The diagnosis, therefore, of recurrent or persistent HAV after PBC, PSC, and overlap syndromes), malignancies (hepatocellular and cholangiocarcinomas), toxic insults, such as alcohol abuse and drug-induced liver injury and hepatic-based metabolic diseases such as α 1 -antitrypsin deficiency and Wilson's disease and extrahepatic metabolic disorders (e.g.…”

Fulminant hepatitis A: Disappearing, but not soon enough

“…In addition, although only a handful of cases have been reported, recurrence of clinical hepatitis A has followed transplantation for fulminant hepatitis A. 5 Estimates of the incidence of acute liver failure in the United States are generally given as 2000-2500 cases annually, yet there is no national registry of cases, and neither death certificate nor discharge coding are sufficiently reliable to confirm these numbers. Hepatitis A has long been considered a minor cause of acute liver failure and death.…”