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DOI: 10.1055/s-0029-1216299
© Thieme Medical Publishers
Patient with Hepatitis B and Alcoholic Liver Disease Before and After Liver Transplantation
Publication History
Publication Date:
22 April 2009 (online)
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ABSTRACT
We present the case of a patient with hepatitis B virus infection and alcohol use (30 g/day by self-report) who developed cirrhosis and proceeded to liver transplantation at age 49. The explanted liver showed cirrhosis with evidence of burnt-out steatohepatitis and hepatitis B virus and a 0.7-cm focus of well-differentiated hepatocellular carcinoma. He was managed following transplant with tacrolimus, prednisone, lamivudine, adefovir, and hepatitis B immune globulin infusions. His post-transplant course was complicated by several episodes of elevated liver enzymes. Liver biopsy 3 months after liver transplantation showed acute rejection and mild steatohepatitis. Liver biopsy 6 months after liver transplantation showed marked steatosis (~95%) with moderate steatohepatitis and evidence of treated rejection. Subsequent biopsies (15 and 21 months post liver transplantation) showed resolution of the steatohepatitis, but development of chronic rejection. We discuss the interaction of alcoholic liver disease and hepatitis B virus in the development of cirrhosis and hepatocellular carcinoma, as well as the role of liver transplantation in these patients.
KEYWORDS
Hepatitis B virus - alcoholic liver disease - cirrhosis - liver transplantation
REFERENCES
- 1 Angus P W, Patterson S J. Liver transplantation for hepatitis B: what is the best hepatitis B immune globulin/antiviral regimen?. Liver Transpl. 2008; 14(Suppl 2) S15-S22
- 2 Pfitzmann R, Schwenzer J, Rayes N, Seehofer D, Neuhaus R, Nüssler N C. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl. 2007; 13(2) 197-205
- 3 Gedaly R, McHugh P P, Johnston T D et al.. Predictors of relapse to alcohol and illicit drugs after liver transplantation for alcoholic liver disease. Transplantation. 2008; 86(8) 1090-1095
- 4 Marcellin P, Pequignot F, Delarocque-Astagneau E et al.. Mortality related to chronic hepatitis B and chronic hepatitis C in France: evidence for the role of HIV coinfection and alcohol consumption. J Hepatol. 2008; 48(2) 200-207
- 5 Poynard T, Mathurin P, Lai C L PANFIBROSIS Group et al. A comparison of fibrosis progression in chronic liver diseases. J Hepatol. 2003; 38(3) 257-265
- 6 Nomura H, Kashiwagi S, Hayashi J et al.. An epidemiologic study of effects of alcohol in the liver in hepatitis B surface antigen carriers. Am J Epidemiol. 1988; 128(2) 277-284
- 7 Gao B. Interaction of alcohol and hepatitis viral proteins: implication in synergistic effect of alcohol drinking and viral hepatitis on liver injury. Alcohol. 2002; 27(1) 69-72
- 8 Larkin J, Clayton M M, Liu J, Feitelson M A. Chronic ethanol consumption stimulates hepatitis B virus gene expression and replication in transgenic mice. Hepatology. 2001; 34(4 Pt 1) 792-797
- 9 Cook R T. Alcohol abuse, alcoholism, and damage to the immune system—a review. Alcohol Clin Exp Res. 1998; 22(9) 1927-1942
- 10 Wands J R, Carter E A, Bucher N L, Isselbacher K J. Inhibition of hepatic regeneration in rats by acute and chronic ethanol intoxication. Gastroenterology. 1979; 77(3) 528-531
- 11 Kim W H, Hong F, Jaruga B et al.. Hepatitis B virus X protein sensitizes primary mouse hepatocytes to ethanol- and TNF-alpha-induced apoptosis by a caspase-3-dependent mechanism. Cell Mol Immunol. 2005; 2(1) 40-48
- 12 Ikeda K, Saitoh S, Suzuki Y et al.. Interferon decreases hepatocellular carcinogenesis in patients with cirrhosis caused by the hepatitis B virus: a pilot study. Cancer. 1998; 82(5) 827-835
- 13 Donato F, Tagger A, Gelatti U et al.. Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol. 2002; 155(4) 323-331
- 14 Gelatti U, Donato F, Tagger A Brescia HCC Study et al. Etiology of hepatocellular carcinoma influences clinical and pathologic features but not patient survival. Am J Gastroenterol. 2003; 98(4) 907-914
- 15 Yusoff I F, House A K, De Boer W B et al.. Disease recurrence after liver transplantation in Western Australia. J Gastroenterol Hepatol. 2002; 17(2) 203-207
- 16 Farges O, Saliba F, Farhamant H et al.. Incidence of rejection and infection after liver transplantation as a function of the primary disease: possible influence of alcohol and polyclonal immunoglobulins. Hepatology. 1996; 23(2) 240-248
- 17 Busuttil R W, Klintmalm G B, Lake J R, Miller C M, Porayko M. General guidelines for the use of tacrolimus in adult liver transplant patients. Transplantation. 1996; 61(5) 845-847
Stephen C WardM.D. Ph.D.
Department of Pathology, The Mount Sinai Medical Center
One Gustave L. Levy Place, New York, NY 10029
Email: Stephen.Ward@mssm.edu