Reappearance of HBsAg with compartmentalized different HBV strains in allograft versus PBMC of the recipient

A woman who was positive for anti-hepatitis B surface antigen (anti-HBs) an d anti-hepatitis B core antigen (anti-HBc) received an orthotopic liver tra nsplantation from an anti-HBc-seropositive donor in November 1985. Reappear ance of hepatitis B surface antigen (HBsAg) was noted 5 months after the tr ansplantation, but it was not associated with significant liver inflammatio n. Ten years after the transplantation, results of serum hepatitis B virus (HBV) DNA study, by nested polymerase chain reaction, were negative. Howeve r, HBV DNA was detected in the transplanted liver tissues and peripheral bl ood mononuclear cells. Different strains were identified in these two organ s. An adw strain was found in the transplanted liver, whereas an adr strain with long segment deletions in the core gene was found in the peripheral b lood mononuclear cells. Covalently closed circular HBV DNA was not detected in any of the tissues examined. Occult HBV infection in the donor as well as the recipient is common in HBV endemic areas. The recipient in this case had reappearance of hepatitis B surface antigen (HBsAg) in the serum after transplantation. Nevertheless, 10 years later, two different strains of HB V were identified in different organs, without cross infection. The present case demonstrates that HBsAg reappearance was not associated with reactiva tion of the virus and liver inflammation. This type of HBsAg reappearance d id not appear to produce a significant hazard to the transplanted liver.