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Hepatitis B reactivation in a renal transplant patient due to a surface antigen mutant strain: a case report.

Abstract：

INTRODUCTION:Reactivation of hepatitis B virus (HBV) is a complication of immunosuppressive treatment in patients with a history of HBV exposure. CASE PRESENTATION:Herein we have reported a case of reactivation after renal transplantation in a 52-year-old male chronic HBV carrier who was treated with hepatitis B immunoglobulin (HBIg) prophylaxis immediately after transplantation in addition to cyclosporine, mycophenolate mofetil and prednisolone for maintenance immunosuppression. After application of rituximab, the patient developed clinical hepatitis with a high load of HBV DNA. Sequence analysis of the surface (S) antigen corresponding to the amino acid residues 101-186 (including the a-determinant region) revealed a genotype D mutant strain, subtype ayw3 with a single amino acid substitution D144E within the S gene. CONCLUSION:This case suggested that immunosuppressive treatment enhanced with rituximab promoted the emergence of an HBV mutant within the determinant region of the S antigen, which escaped HBIg immunoprophylaxis causing HBV reactivation in a kidney transplant recipient.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Fylaktou A,Daoudaki M,Dimou V,Sianou E,Papaventsis D,Mavrovouniotis I,Fouzas I,Papanikolaou V

doi

10.1016/j.transproceed.2012.09.011

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

2773-5

issue

9

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(12)00992-X

journal_volume

44

pub_type

杂志文章

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