A Ramji, K Gutfreund¹, S Erb, J Davis, U Steinbrecher, C Sherlock, C Scudamore, S Chung, M Williams¹, EM Yoshida

Departments of Medicine, Surgery, Microbiology, University of British Columbia, Vancouver, British Columbia, ¹University of Alberta, Edmonton, Alberta, and BC Transplant Society, Vancouver, British Columbia, Canada

Introduction: De novo HBV infection post-liver transplantation (LT) from an anti-HBc seropositive donor rarely presents as acute failure.

Case Report: A 42 year-old Caucasian female, HBsAg and HBcAb seronegative,with primary biliary cirrhosis receive an allograft from a donor that was HBsAg negative, anti-HBc positive.  Post-LT the patient was vaccinated against HBV with a polyclonal vaccine and one-year post-LT had an anti-HBs titre of 256 IU/L.  Two years post-LT, she developed an increase in serum aminotransferases and worsening liver function with an INR of 2.0.  HBsAg was now positive, anti-HBs undetectable and serum HBV-DNA > 2000 pg/ml (Digene Hybrid Capture).  Liver biopsy revealed significant ballooning degeneration and piecemeal necrosis with positive immunostaining for HBcAg.  The patient developed increasing liver failure, sepsis and terminal multi-organ failure.

Subsequent genotypic analysis of the HBV by cycle-sequencing of PCR product revealed mutations in the "a" determinant: Met 133 Thr (ATG to ACG) and Asn 131 Thr.

Conclusion:  We report acute de novo HBV infection two years post-LT despite protective anti-HBs titres post-vaccination with a rarely reported "a" determinant mutated strain of HBV.

Supported by a grant from Fujisawa-Canada Inc.

NEXT ABSTRACT >