@article {4510,
	title = {Reactivation of hepatitis B virus with mutated hepatitis B surface antigen in a liver transplant recipient receiving a graft from an antibody to hepatitis B surface antigen- and antibody to hepatitis B core antigen-positive donor.},
	journal = {Transfusion// // Transfusion},
	volume = {52},
	year = {2012},
	month = {2012//},
	pages = {1999 - 2006},
	address = {United States},
	abstract = {BACKGROUND: Fresh-frozen plasma (FFP) may contain antibodies to hepatitis B surface antigen (HBsAg, anti-HBs). These anti-HBs may lead to a misinterpretation of the actual hepatitis B immune status. Furthermore, they may not only confer protection against hepatitis B virus (HBV), but may also favor the selection of HBsAg mutants., CASE REPORT: We report a case of de novo HBV infection in a HBV-naive recipient with alcoholic liver disease, who received a liver from a donor with antibodies to hepatitis B core antigen (HBcAg, anti-HBc) and anti-HBs., RESULTS: A lookback investigation revealed the following: 1) Due to anti-HBs passively acquired through FFP, the recipient was considered immune to HBV and did not receive anti-HBV prophylaxis. 2) Within 1 year after transplantation he developed hepatitis B in absence of any elevated liver enzymes after the anti-HBs by FFP declined. 3) Despite an infection with HBV-containing wild-type HBcAg, the patient did not seroconvert to anti-HBc positivity. 4) The replicating HBV encoded two HBsAg mutations, first sQ129R and 4 months later sP127S. They map to the highly conserved "alpha" determinant of the HBsAg loop., CONCLUSION: 1) Passive transfer of anti-HBs from FFP led to an erroneous pretransplant diagnosis of HBV immunity when the patient was in fact HBV-naive. 2) HBsAg mutations might have been selected in escape from donor{\textquoteright}s actively produced anti-HBs and the recipient{\textquoteright}s anti-HBs by FFP might have favored this selection. 3) It is doubtful whether hepatitis B immunoglobulin could have prevented the reactivation. 4) Antiviral prophylaxis would have been crucial.Copyright {\textcopyright} 2012 American Association of Blood Banks.},
	keywords = {*Hepatitis B Antibodies/bl [Blood], *Hepatitis B Surface Antigens/ge [Genetics], *Hepatitis B virus/ph [Physiology], *Hepatitis B/tm [Transmission], *Liver Transplantation/ae [Adverse Effects], *Virus Activation/ph [Physiology], Hepatitis B Core Antigens/im [Immunology], Hepatitis B Surface Antigens/im [Immunology], Hepatitis B virus/ge [Genetics], Hepatitis B virus/im [Immunology], Hepatitis B/bl [Blood], Hepatitis B/et [Etiology], Hepatitis B/vi [Virology], Humans, Male, Middle Aged, Mutation/ph [Physiology], Tissue Donors},
	isbn = {1537-2995},
	author = {Blaich, Annette and Manz, Michael and Dumoulin, Alexis and Schuttler, Christian G and Hirsch, Hans H and Gerlich, Wolfram H and Frei, Reno}
}
