FULMINANT-HEPATITIS-B VIRUS - RECURRENCE AFTER LIVER-TRANSPLANTATION IN 2 PATIENTS ALSO INFECTED WITH HEPATITIS-DELTA VIRUS

Liver transplantation for hepatitis B virus (HBV)-related liver diseas e is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV) -related cirrhosis are reported to have a diminished incidence of HBV recurrence and improved graft survival. However, only a few reported H DV-infected patients had active HBV replicative disease before liver t ransplantation, In our experience, we transplanted two HDV-infected pa tients, both of whom had active HBV replication before liver transplan tation. In one patient, hepatitis B surface antigen (HBsAg) recurred f our months after transplantation. Two months later, Hepatitis Be antig en (HBeAg) and HBV-DNA became positive, and the patient died of fulmin ant recurrent hepatitis B and hepatitis delta, In the other patient, H BV persisted after transplantation, and 2 months later the patient req uired retransplantation for fulminant recurrent hepatitis B and hepati tis delta, With the second graft, the patient remained free of HBV inf ection for 1 year, Thereafter, the patient experienced HBV recurrence with active replication and died of fulminant hepatitis B and delta re currence, In the first case and in the second graft of the second case , hepatitis B immunoglobulin (HBIG) immunoprophylaxis was administered in an attempt to prevent recurrence of HBV. The literature suggests t hat an HDV infection inhibits the replication of HBV and therefore pla ys a role in preventing the recurrence of HBV and improving survival, Our experience with two patients suggests that HDV infection, in the p resence of active HBV replication, may not play a protective role.