Clinical and virologic outcomes of hepatitis B and C viral coinfection after liver transplantation: Effect of viral hepatitis D

Hepatitis B (HBV) and C viral (HCV) dual-infection-associated liver disease is an uncommon indication for liver transplantation, The clinical and viro logic outcomes in such patients have not been well studied. We retrospectiv ely studied 13 patients with hepatitis B surface antigen (HBsAg) and antibo dy to HCN positivity who underwent orthotopic liver transplantation (OLT) a nd survived at least 30 days post-OLT. Antibody to hepatitis delta virus (H DV) was negative in 8 patients (group I) and positive in 5 patients (group II). Eleven of the 13 patients received standard hepatitis B immune prophyl axis, and they all remained HBsAg negative. All group I patients were HCV R NA positive after transplantation; in contrast, all group II patients were HCV RNA negative. Serum alanine aminotransferase levels were elevated in 88 % (7 of 8) of the patients in group I compared with 20% (1 of 5 patients) i n group II. None of the patients had graft loss from chronic rejection or r ecurrent hepatitis. Three patients had unsuspected hepatocellular carcinoma in the explant, We conclude that among Liver transplant recipients with HB V and HCV coinfection, HDV infection is associated with the suppression of HCV replication and mild inflammatory activity after OLT. Copyright (C) 200 0 by the American Association for the Study of Liver Diseases.