Hepatitis A Virus (HAV) Recurrence and De Novo Hepatitis A Acquired at Time of Liver Transplantation: Comparison of Graft HAV Infection and Viral Kinetics.
David Mutimer, Elinor Latham, Sowsan F Atabani et al.
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Case in brief
Two liver transplant recipients developed hepatitis A virus (HAV) infection of the graft in different settings. A recipient transplanted for HAV-related acute liver failure had a rapid fall in serum HAV RNA after removal of the native liver, followed by recurrent viraemia with graft hepatitis in the second and third post-transplant months; HAV RNA cleared by 4 months. A second recipient, transplanted for paracetamol-induced acute liver failure, acquired HAV through peri-operative blood transfusion while profoundly immunosuppressed and without pre-existing immunity. This patient had a higher peak viral load, viraemia lasting over 9 months, and more severe graft hepatitis.
What made this case unusual
The report contrasts recurrent graft infection after transplantation for HAV with transfusion-acquired de novo infection, documenting distinct viral kinetics and clinical severity in the two immunological contexts.
Diagnostic / clinical pearl
A rapid post-transplant fall in HAV RNA after removal of an infected native liver does not exclude subsequent graft recurrence; serial HAV RNA measurements can help characterize recurrence or newly acquired infection.
Why it matters
The cases show that de novo HAV acquired during profound immunosuppression and without pre-existing immunity may be associated with sustained high-level viraemia and more severe graft hepatitis than recurrent infection.