Record to update:
Adverse Occurrence type:
MPHO Type:
Estimates Frequency:
Cannot be determined. This is a report of a single liver transplant. The study did not report whether the donor was a multi-organ donor or if HBV was present in any other transplanted organs, if any were donated and transplanted..Thus the efficiency of a transplanted organ containing HBV virus to become reactivated cannot be determined.
Time to detection:
An accurate incubation period or time to first develop signs or symptoms cannot be determined. The posttransplant course was unremarkable. No clinical signs or symptoms of hepatitis.
Positive tests for HBsAg and HBeAg were surprisingly found during a routine one-year postransplant national study; testing for anti-HBc was negative and liver enzyme levels were normal.
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Alerting signals, symptoms, evidence of occurrence :
The liver donor was positive for anti-HBc and anti-HBs and negative for HBsAg.The donated liver showed macrosteatosis without active hepatitis or cirrhosis and was negative for HBV DNA, HBsAg and HBV deta antigen.
During the initial days after the transplantation, there were some positive tests for anti-HBs and anti-HAV but these were transitory and were due to passive transfer from plasma transfusions. Because these tests for HBV antibodies were present, the patient was presumed to have had a previous HBV infection and HBV immunization, hepatitis B immunoglobulin and antiviral prophylaxix was withheld.
At the time of transplant the recipient did not have anti-HBc, anti-HBsAg, HBsAg, HBV DNA or abnormal liver enzyme levels in blood.
There were no alerting signs or symptoms of a HBV liver infection. Positive tests for HBsAg and HBeAg were surprisingly found during a routine one-year postransplant national study; Testing for anti-HBc was negative throughout the patient's hospitalization and liver enzyme levels were normal.
A mutant HBV infection was discovered producing HBsAg and HBeAg and was highly productive of HBV DNA without causing abnormal liver function tests or clinical disease. Following anti-viral treatment, the high HBV DNA levels decilned to very low levels and an HBV mutant became undetectable. HBsAg remained persistently detectable but anti-HBc and anti-HBs remained persistently undetectable.
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Demonstration of imputability or root cause:
The HBV surface antigen mutant was detected by characterization of the HBV strain with direct sequencing of the entire surface gene. It produced HBsAg and large quantities of HBV DNA without production of anti-HBc. It did not produce clinical hepatitis symptoms or liver enzyme elevations.. It declined with anti-viral treatment. There were no other risk factors for HBV infection, no evidence of transfusion transmission and the authors proposed that the
mutant HBV arose from the transplanted liver.
Imputability grade:
1 Possible
Groups audience:
Suggest new keywords:
hepatitis B virus, HBV, hepatitis, HBV mutant, mutation, liver transplantation, donor infection,
Adverse occurrence description:
Posttransplantation reactivation of a HBsAg mutant, hepetitis B virus in a transplanted liver
Expert comments for publication:
This study demonstrated the development of an asymptomatic mutant HBV infection long after liver transplantation. The authors propose it arose in the donor's transplanted liver.
The study also demonstrated that positive tests for anti-HBs can be detected from the passive infusion of plasma transfusions and that these test results can erroneously lead to the false interpretation that the patient had a previous resolved HBV infection.