A Young Female Underwent Liver Transplantation

DISCUSSION

This is an unusual presentation of acute HAV infection causing liver failure and requiring a liver transplant. HAV usually presents as an acute infection ranging from mild to severe disease, does not have a chronic clinical form, and less than 1% can develop liver failure. About a third of patients with acute liver failure secondary to HAV need a transplant, while the other two thirds recover spontaneously (5). Preexisting liver conditions like non-alcoholic and alcoholic liver disease makes individuals more susceptible to develop liver failure. This is consistent with what we observed in our patient, as the possibility of an underlying chronic steatohepatitis (as mentioned in the first biopsy) could not be entirely excluded. Further complicating the situation is the empiric observation that HAV hepatitis can trigger the onset of AIH particularly in susceptible individuals. Finally, recurrent HAV infection after liver transplantation is even rarer and only a handful of cases have been reported in the literature.

REFERENCES

1. Vento S, et al. Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals. Lancet 1991, vol 337, issue 8751, 1183-1187
2. Fagan E, et al. Persistence of hepatitis A virus in fulminant hepatitis and after liver transplantation. Journal of Medical Virology 30: 131-136 (1990).
3. Eisenbach C, et al. Recurrence of clinically significant hepatitis A following liver transplantation for fulminant hepatitis A. Journal of Clinical Virology 35 (2006) 109-112.
4. Park GC, et al. Intractable recurrent hepatitis A virus infection requiring repeated liver transplantation: a case report. Transplantation Proceedings, 42, 4658-4660 (2010).
5. Taylor RM, et al. Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology 2006; 44: 1589-1597.

Contributed by Hugo Kaneku, MD and Marta Minervini, MD