THE INDICATORS OF LIVER TRANSPLANTATION FOR THE FIRST EPISODE OF HEPATITIS B-RELATED ACUTE LIVER FAILURE.

Case report: We present a young female of fourteen years who was admitted to the hospital with short duration of Icterus, malaise, vomiting and diagnosed to be having acute hepatitis B. She went into acute liver failure as evidenced by development of hepatic encephalopathy and coagulopathy. She was managed on lines of hepatic encephalopathy along with oral antiviral treatment. She recovered successfully and was discharged after two weeks in heamodynamically stable condition. After a gap of six months, she became Hepatitis B surface (HbsAg) & hepatitis B e-antigen (HbeAg) negative and Hepatitis B Virus DNA (HBV DNA) was undetectable with normal liver function tests. She is on regular follow up for last one year and is absolutely normal. Conclusion: Acute hepatitis B can go into acute liver failure in 1% of cases, treatment for which includes liver transplantation and oral antiviral treatment which is especially helpful in cases who cannot afford liver transplantation, as was in our case.

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Human genomics of acute liver failure due to hepatitis B virus infection: an exome sequencing study in liver transplant recipients

10.1101/320374 ◽

2018 ◽

Author(s):

Samira Asgari ◽

Nimisha Chaturvedi ◽

Petar Scepanovic ◽

Christian Hammer ◽

Nasser Semmo ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatitis B Virus ◽

Mortality Rate ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Fulminant Hepatitis ◽

Clinical Presentation ◽

Hbv Infection ◽

B Virus

AbstractAcute liver failure (ALF) or fulminant hepatitis is a rare, yet severe outcome of infection with hepatitis B virus (HBV) that carries a high mortality rate. The occurrence of a life-threatening condition upon infection with a prevalent virus in individuals without known risk factors is suggestive of pathogen-specific immune dysregulation. In the absence of established differences in HBV virulence, we hypothesized that ALF upon primary infection with HBV could be due to rare deleterious variants in the human genome. To search for such variants, we performed exome sequencing in 21 previously healthy adults who required liver transplantation upon fulminant HBV infection and 172 controls that were positive for anti-HBc and anti-HBs antibodies but had no clinical history of jaundice or liver disease. After a series of hypothesis-driven filtering steps, we searched for putatively pathogenic variants that were significantly associated with case-control status. We did not find any causal variant or gene, a result that does not support the hypothesis of a shared monogenic basis for human susceptibility to HBV-related ALF in adults. This study represents a first attempt at deciphering the human genetic contribution to the most severe clinical presentation of acute HBV infection in previously healthy individuals.Author SummaryInfection with hepatitis B virus (HBV) is very common and causes a variety of liver diseases including acute and chronic hepatitis, cirrhosis and liver carcinoma. Acute HBV infection is often asymptomatic, still about 1% of newly infected people develop a rapid and severe disease known as acute liver failure or fulminant hepatitis. Acute liver failure has a high mortality rate and is an indication for urgent liver transplantation. It is not clear why some people, who are otherwise healthy, develop such severe symptoms upon infection with a common pathogen. Here, we hypothesized that rare DNA variants in the human genome could contribute to this unusual susceptibility. We sequenced the exome (i.e. the regions of the genome that encode the proteins) of 21 previously healthy adults who required liver transplantation upon fulminant HBV infection and searched for rare genetic variants that could explain the clinical presentation. We did not identify any variant that could be convincingly linked to the extreme susceptibility to HBV observed in the study participants. This suggests that HBV-induced acute liver failure is more likely to result from the combined influence of multiple genetic and environmental factors.

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Immune Thrombocytopenia Associated with Hepatitis B Virus and Autoimmune Hepatitis and Recovery of Platelet Count following Liver Transplantation

Case Reports in Transplantation ◽

10.1155/2021/8484106 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Chloe Nobuhara ◽

Diana M. Cardona ◽

Murat O. Arcasoy ◽

Carl L. Berg ◽

Andrew S. Barbas

Keyword(s):

Liver Transplantation ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Autoimmune Hepatitis ◽

Immune Thrombocytopenia ◽

First Case ◽

Thrombopoietin Receptor ◽

B Virus

Immune thrombocytopenia is a consumptive coagulopathy that can be either idiopathic or associated with infectious or autoimmune etiologies. Here, we present a case of immune thrombocytopenia in the setting of acute liver failure due to coexisting diagnoses of hepatitis B virus and autoimmune hepatitis. Our patient underwent orthotopic liver transplantation and recovered hemostatic platelet counts after treatment with romiplostim, a thrombopoietin receptor agonist, 51 days after transplantation. To our knowledge, this is the first case report of immune thrombocytopenia secondary to both hepatitis B virus and autoimmune hepatitis in a patient with acute liver failure.

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Etiologies and Outcomes of Acute Liver Failure in a Spanish Community

International Journal of Hepatology ◽

10.1155/2013/928960 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Emilio Fábrega ◽

Miguel Ángel Mieses ◽

Alvaro Terán ◽

Irene Moraleja ◽

Fernando Casafont ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Term Survival ◽

Acetaminophen Overdose ◽

Acute Hepatitis B ◽

Toxic Reactions ◽

Short Term Survival

Previous retrospective study (1992 to 2000) performed in Spain showed that drug toxicity, viral hepatitis, and indeterminate etiology were the most prevalent causes of acute liver failure (ALF). In the last decade, there is no information about ALF in our country. For these reasons we analyze retrospectively, in a ten-year period (2000 to 2010), the presumed causes, clinical characteristics, course, and outcome of ALF in a Spanish community. Causes of ALF were indeterminate in 4 patients (24%), acute hepatitis B infection in 4 patients (24%), drug or toxic reactions in 4 patients (24%), including one case of acetaminophen overdose, followed by miscellaneous causes. The overall short-term survival (6 weeks after admission) was 65%. Liver transplantation was performed in 11 patients with a survival of 82%. Despite fulfilling criteria, 2 patients were not transplanted because of contraindications; they both died. In summary, acute hepatitis B and indeterminate cause are still being the most frequent causes of ALF in our region, and patients with ALF have an excellent chance of survival after emergency liver transplantation. Acetaminophen overdose still represents a very rare cause of ALF in our community.

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