Journal article

Publication year: 2012

Pages: 1999-2006

Journal: Transfusion

Volume number: 52

Issue number: 9

ISSN: 0041-1132

eISSN: 1537-2995

Open access status: Green

DOI Link: https://doi.org/10.1111/j.1537-2995.2011.03537.x

Publisher: Wiley

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 a 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's actively produced anti-HBs and the recipient'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.

Harvard Citation style: Blaich, A., Manz, M., Dumoulin, A., Schuettler, C., Hirsch, H., Gerlich, W., et al. (2012) 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, Transfusion, 52(9), pp. 1999-2006. https://doi.org/10.1111/j.1537-2995.2011.03537.x

APA Citation style: Blaich, A., Manz, M., Dumoulin, A., Schuettler, C., Hirsch, H., Gerlich, W., & Frei, R. (2012). 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. Transfusion. 52(9), 1999-2006. https://doi.org/10.1111/j.1537-2995.2011.03537.x