Status:
Ready to upload
Record number:
1714
Adverse Occurrence type:
MPHO Type:
Time to detection:
16 months
Alerting signals, symptoms, evidence of occurrence:
A 24 year old male received a renal transplant for polycystic kidney disease from a deceased donor known to be HBsAg positive. The recipient was HBsAg and anti-HBcore Ag negative pre-transplant, with low level anti-HBsAg due to previous vaccination. He received a booster dose of HBV vaccine and HBIg at the time of transplant. He was not put on antiviral for HBV. Sixteen months post transplant he was admitted with AST 530U/L, ALT 1023U/L, AP 345 U/L, total bilirrubin 6.23 mg/L, HBsAg 287 mIU/ml, anti-HBsAg>1000 mIU/ml, anti-HBcore and HBeAg positive, HBV DNA 2.11x10^8 IU/ml. He was commenced on entecavir but progressed to fulminant liver failure with encephalopathy and was entered in the liver transplant list, but died shortly after.
Demonstration of imputability or root cause:
Full genome sequence of the recipient's HBV strain was obtained. Genotype D2 was assigned and multiple mutations were identified in the core pre-core, polymerase, pre-S, and the X region, including G145R and K160N in the S gene. This paper focuses on the selection of virus variant populations under the selective pressure of HBV hyper immunoglobulin and HBV vaccine booster given at the time of transplant. No information on the donor virus strain is given.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
HBV escape mutant
HBV variant
G145R mutation
entecavir
lamivudine
fulminant hepatitis
HBV hyperimmunoglobulin
HBV vaccine
Reference attachment:
Suggest references:
Renal transplantation from hepatitis B surface antigen (HBsAg)-positive donors to HBsAg-negative recipients: a case of post-transplant fulminant hepatitis associated with an extensively mutated hepatitis B virus strain and review of the current literature. Magiorkinis E et al. Transpl Infect Dis. 15(4):393-9, 2013 Aug.
Expert comments for publication:
Use of anti-HBV antiviral treatment with monitoring of HBV DNA should be part of the management of recipients receiving allografts from HBsAg positive donors, regardless of pre-transplant HBV immune status.