Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Friday, 05 / 14 / 2021

Articles

REVIEW ARTICLE

Occult Hepatitis B Reactivation after Liver Transplant: The Role of a Novel Mutation in the Surface Antigen

Harjot K. Bedi1, Daljeet Chahal1,2, Christopher F. Lowe3, Gordon Ritchie3Trana Hussaini4Vladimir Marquez1,2 and Eric M. Yoshida*,1,2

1  Department of Medicine, University of British Columbia, Vancouver, BC, Canada
2  Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
3  Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
4  Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
*Correspondence to: Eric M. Yoshida, Vancouver General Hospital, University of British Columbia, 5th Floor – 2775 Laurel Street, Vancouver, BC, Canada. Tel: +1-604-875-5244, Fax: +1-604-875-5447, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(1):136-138 DOI: 10.14218/JCTH.2020.00090
Received: September 26, 2020 Accepted: November 19, 2020 Published online: December 7, 2020

Abstract

Occult hepatitis B infection is characterized by loss of hepatitis B surface antigen (HBsAg) and persistence of low levels of hepatitis B virus (HBV) replication that may or may not be detectable in plasma/serum. We present a case of HBV reactivation in a male patient who underwent orthotopic liver transplant for hepatocellular carcinoma secondary to active hepatitis C (HCV) infection. Pre-transplant, he was HBsAg-negative and hepatitis B core antibody-positive, with an undetectable HBV viral load that was incidentally found to be positive at a very low HBV viral load on the day of transplant. Post-transplant, his HBsAg remained undetectable, with an undetectable HBV viral load, until eradication of his HCV infection with direct acting antiviral agents. After eradication of HCV, there was reactivation of HBV, with a high viral load and emergence of serum HBsAg. A deep sequencing genetic analysis of his HBV both pre- and post-transplant revealed the presence of a mutation in the “a” determinant of the HBV surface antigen. The role of HBV genotype ‘a’ determinant mutation in HBV reactivation post-transplant is unknown and needs further examination. Our experience suggests a possible role for antiviral prophylaxis in these patients or monitoring of HBV viral loads post-transplant.

Keywords

Hepatitis, Hepatitis B, Reactivation, Seroconversion, Liver transplant, Transplant

Journal of Clinical and Translational Hepatology 2021 vol. 9, 136-138  [ Html  ] [ PDF Full-text ]

© The Author(s) 2021. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 logo

You are here: Home