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KMID : 1188320110050020248
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Gut and Liver
2011 Volume.5 No. 2 p.248 ~ p.252
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De Novo Superinfection of Hepatitis B Virus in an Anti-HBs Positive Patient with Recurrent Hepatitis C Following Liver Transplantation
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Ha Sung-Hae
Park Young-Min
Hong Sun-Pyo
Back So-Ya
Shin Soo-Kyeong
Ji Seung-Il
Kim Soo-Ok
Yoo Wang-Don
Kim Bo-Hyun
Park Sang-Jong
Hong Zheng
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Abstract
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A 60-year-old woman with end stage liver cirrhosis caused by genotype 2 hepatitis C virus (HCV) infection received an orthotopic liver transplantation (OLT). The patient was negative for the hepatitis B surface antigen (HBsAg) and positive for the anti-hepatitis B surface antibody (anti-HBs) prior to and one and a half months following the OLT. Due to reactivation of hepatitis C, treatment with interferon-alpha and Ribavirin started two months following the OLT and resulted in a sustained virological response. We performed a liver biopsy because a biochemical response was not achieved. Surprisingly, liver pathology showed HBsAg-positive hepatocytes with a lobular hepatitis feature, which had been negative in the liver biopsy specimen obtained one and a half months post- OLT. High titers of both HBsAg and HBeAg were detected, while anti-HBs antibodies were not found. Tests for IgM antihepatitis B core antibody and anti-delta virus antibodies were negative. The serum HBV DNA titer was over 1×107 copies/ mL. A sequencing analysis showed no mutation in the ""> determinant region, but revealed a mixture of wild and mutant strains at an overlapping region of the S and P genes (S codon 213 (Leu/Ile); P codons 221 (Phe/Tyr) and 222 (Ala/ Thr)). These findings suggest that de novo hepatitis B can develop in patients with HCV infection during the post-OLT period despite the presence of protective anti-HBs.
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KEYWORD
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De novo hepatitis B virus infection, Occult hepatitis B virus infection, Post-orthotopic liver transplantation recurrent hepatitis C, Orthotopic liver transplantation
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