Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases
Hepatitis B virus (HBV) related acute liver failure (ALF) is uncommon in our region, and there is limited HBV literature regarding the optimal management of these cases. In this article, we report two clinical cases of young men who have sex with men (MSM), both developed severe acute hepatitis caus...
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doaj-b3d65fcffaa041cba2a5c4ed713f55b62021-06-09T05:56:28ZengElsevierAnnals of Hepatology1665-26812021-03-0121100107Liver transplantation in acute liver failure due to Hepatitis B. Two clinical casesRocío Sedano0Lorena Castro1Mauricio Venegas2Julio Miranda3Carmen Hurtado4Jaime Poniachik5Javier Brahm6Servicio Medicina Interna, Departamento de Gastroenterología, Hospital Clinico de la Universidad de Chile, Santos Dumont 999, Independencia, 8380456 Santiago, ChileServicio de Gastroenterología, Clínica Las Condes, Estoril 450, Las Condes, 7591047 Santiago, ChileServicio Medicina Interna, Departamento de Gastroenterología, Hospital Clinico de la Universidad de Chile, Santos Dumont 999, Independencia, 8380456 Santiago, ChileServicio Medicina Interna, Departamento de Gastroenterología, Hospital Clinico de la Universidad de Chile, Santos Dumont 999, Independencia, 8380456 Santiago, ChileServicio Medicina Interna, Departamento de Gastroenterología, Hospital Clinico de la Universidad de Chile, Santos Dumont 999, Independencia, 8380456 Santiago, ChileServicio Medicina Interna, Departamento de Gastroenterología, Hospital Clinico de la Universidad de Chile, Santos Dumont 999, Independencia, 8380456 Santiago, ChileServicio de Gastroenterología, Clínica Las Condes, Estoril 450, Las Condes, 7591047 Santiago, Chile; Corresponding author at:Hepatitis B virus (HBV) related acute liver failure (ALF) is uncommon in our region, and there is limited HBV literature regarding the optimal management of these cases. In this article, we report two clinical cases of young men who have sex with men (MSM), both developed severe acute hepatitis caused by HBV, progressed to ALF and afterward required liver transplantation. Antiviral post-transplant treatment included entecavir without Hepatitis B Immunoglobulin (HBIG), and immunosuppression therapy with steroids, tacrolimus, and mycophenolate. Serologic follow-up showed early Hepatitis B surface Antigen (HBsAg) seroconversion, undetectable HBV viral load, and positive Anti-HBs titers. During later follow-up, Anti-HBs titers gradually fell (<10 mUI/L after six months), with normal liver function. Discussion: In cases of HBV-related ALF, the liver develops a robust immune response, leading to, an early undetectable viral load and seroconversion, with loss of HBsAg, and the appearance of Anti-HBs as a result of the inflammatory response. The management varies depending on whether this is a de novo acute infection or a reactivation of a previous chronic infection. In both cases, the use of antiviral therapy is recommended, with entecavir or tenofovir, among others, but the use of specific HBIG is supported only in ALF related to chronic HBV infection. The optimal length of the antiviral therapy after liver transplantation is still under discussion. Conclusion: These cases of HBV related ALF with an early HBsAg seroconversion demonstrates the relevance of requesting IgM antibody against hepatitis B core antigen (anti-HBc IgM) for the etiological study of ALF with negative HBsAg. Usage of HBIG does not seem essential during the post-transplantation period in these cases.http://www.sciencedirect.com/science/article/pii/S1665268119322136Liver transplantationAcute liver failureHepatitis B |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rocío Sedano Lorena Castro Mauricio Venegas Julio Miranda Carmen Hurtado Jaime Poniachik Javier Brahm |
spellingShingle |
Rocío Sedano Lorena Castro Mauricio Venegas Julio Miranda Carmen Hurtado Jaime Poniachik Javier Brahm Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases Annals of Hepatology Liver transplantation Acute liver failure Hepatitis B |
author_facet |
Rocío Sedano Lorena Castro Mauricio Venegas Julio Miranda Carmen Hurtado Jaime Poniachik Javier Brahm |
author_sort |
Rocío Sedano |
title |
Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases |
title_short |
Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases |
title_full |
Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases |
title_fullStr |
Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases |
title_full_unstemmed |
Liver transplantation in acute liver failure due to Hepatitis B. Two clinical cases |
title_sort |
liver transplantation in acute liver failure due to hepatitis b. two clinical cases |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2021-03-01 |
description |
Hepatitis B virus (HBV) related acute liver failure (ALF) is uncommon in our region, and there is limited HBV literature regarding the optimal management of these cases. In this article, we report two clinical cases of young men who have sex with men (MSM), both developed severe acute hepatitis caused by HBV, progressed to ALF and afterward required liver transplantation. Antiviral post-transplant treatment included entecavir without Hepatitis B Immunoglobulin (HBIG), and immunosuppression therapy with steroids, tacrolimus, and mycophenolate. Serologic follow-up showed early Hepatitis B surface Antigen (HBsAg) seroconversion, undetectable HBV viral load, and positive Anti-HBs titers. During later follow-up, Anti-HBs titers gradually fell (<10 mUI/L after six months), with normal liver function. Discussion: In cases of HBV-related ALF, the liver develops a robust immune response, leading to, an early undetectable viral load and seroconversion, with loss of HBsAg, and the appearance of Anti-HBs as a result of the inflammatory response. The management varies depending on whether this is a de novo acute infection or a reactivation of a previous chronic infection. In both cases, the use of antiviral therapy is recommended, with entecavir or tenofovir, among others, but the use of specific HBIG is supported only in ALF related to chronic HBV infection. The optimal length of the antiviral therapy after liver transplantation is still under discussion. Conclusion: These cases of HBV related ALF with an early HBsAg seroconversion demonstrates the relevance of requesting IgM antibody against hepatitis B core antigen (anti-HBc IgM) for the etiological study of ALF with negative HBsAg. Usage of HBIG does not seem essential during the post-transplantation period in these cases. |
topic |
Liver transplantation Acute liver failure Hepatitis B |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119322136 |
work_keys_str_mv |
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