OCCURRENCE AND MANAGEMENT OF HEPATITIS-B VIRUS REACTIVATION FOLLOWINGKIDNEY-TRANSPLANTATION

A 28-year-old woman was kidney transplanted. She had an inapparent hep atitis B virus (HBV) infection 2 years previously. At the time of tran splantation she was hepatitis B surface antigen (HBsAg) negative, anti -HBs, anti-HBc, anti-HBe and anti-HCV antibody positive and her transa minase activities were within the normal range. The donor of the kidne y allograft was HBV negative. Twelve weeks after transplantation a Lif e-threatening liver failure occurred with a rapid rise of alanine amin otransferase (ALT) to 1427 U/l and a decrease of the prothrombin time to 25% of normal value. Anti-HBs had become negative, anti-HBc and ant i-HBe titers had decreased. HBsAg became positive, associated with a H BV DNA of 3 x 10(8) genome equivalents/ml. Azathioprine and prednisone were withdrawn and foscarnet therapy was started. This therapy led to a decrease of ALT activity associated with an elimination of HBsAg an d HBV DNA. Eight months after transplantation liver function tests wer e within the normal range. Graft rejection did not occur despite low o r intermittent cessation of immunosuppressive therapy.