Outcome of Hepatitis B Virus DNA-Positive Liver Transplantation in Hepatitis B Virus/Hepatitis D Virus Co-Infected Recipient Treated with High Dose Hepatitis B Immune Globulin: A Case Report
1Gastroenterology and Hepatology, Johns Hopkins, Baltimore, MD, 2Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, 3Transplant Surgery, Johns Hopkins, Baltimore, MD
Meeting: 2020 American Transplant Congress
Abstract number: C-200
Keywords: Hepatitis, Infection, Liver transplantation
Session Information
Session Name: Poster Session C: Non-Organ Specific: Viral Hepatitis
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Introduction: While common in Asian countries, liver transplantation (LT) for patients with hepatitis B virus (HBV)/hepatitis D virus (HDV) co-infection is rare in the US; only 8 cases were reported in 2018. Post-transplant re-infection with HBV/HDV is commonly treated with hepatitis B immune globulin (HBIG) and antiviral drugs; however, data regarding dosage and frequency of HBIG therapy is limited. We report the outcome of HBV DNA-positive LT in a patient with chronic HBV/HDV co-infection.
*Methods: Case Presentation: A 34-year-old non-alcoholic Asian male with a history of liver cirrhosis secondary to chronic HBV/HDV co-infection underwent a successful LT from a CDC (Centers for Disease Control and Prevention) increased risk donor. Prior to LT, the recipient was HBsAg positive, HBcAb IgG+IgM positive, HBsAb negative, HCV Ab negative, and HCV RNA negative; was on Tenofovir Disoproxil Fumarate (TDF); and had undetectable HBV DNA but detectable HDV DNA. The donor was HBsAg negative, HbcAb IgG+IgM negative, and HBV DNA positive. The recipient was treated with HBIG 9,360 units IV daily for 7 days, with the first dose given intra-operatively and TDF was switched to Tenofovir Alafenamide (TAF). HBsAg and HBsAb titer were initially checked weekly and then monthly and HBIG 9,360 units IV were given if HBsAb was <500 m[IU]/mL. Twelve months post LT, the recipient continued to have negative HBsAg, undetectable HBV DNA, and undetectable HDV RNA (Table 1). Liver function tests remain normal.
*Results: Table 1: Hepatitis B and D serology pre and post liver transplantation
| Prior to LT | POD # 4 | POD # 7 | 2 months post LT | 12 months post LT | |
| HBsAg | + | – | – | – | – |
| HBsAb | – | + | |||
| HBsAb titer(m[IU]/ml | >1000 | >1000 | 566.2 m | 766.5 | |
| HBV DNA | undetectable | undetectable | undetectable | undetectable | |
| HDV RNA | detectable | undetectable | undetectable | undetectable |
LT, liver transplant. POD, post operative day.
*Conclusions: Conclusions: Based on our single case experience and current lack of approved HDV antiviral treatment, high doses of HBIG are used to adequately suppress the HBsAg. This remains a key element in the management of HDV co-infection since long-term suppression of HBsAg is pivotal to prevent HDV recurrence. HBV antiviral treatment alone may not be adequate to achieve this goal.
To cite this abstract in AMA style:
Hammami MB, Haris M, Toman L, Danis N, Saberi B, King E, Garonzik-Wang J, Philosophe B, Cameron AM, Gurakar A. Outcome of Hepatitis B Virus DNA-Positive Liver Transplantation in Hepatitis B Virus/Hepatitis D Virus Co-Infected Recipient Treated with High Dose Hepatitis B Immune Globulin: A Case Report [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcome-of-hepatitis-b-virus-dna-positive-liver-transplantation-in-hepatitis-b-virus-hepatitis-d-virus-co-infected-recipient-treated-with-high-dose-hepatitis-b-immune-globulin-a-case-report/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress