Hepatitis D virus reinfection following liver transplantation
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
- Section Editor
- Robert S Brown, Jr, MD, MPH
Robert S Brown, Jr, MD, MPH
- Section Editor — Liver Transplantation
- Vice Chair, Transitions of Care, Department of Medicine
- Interim Chief, Division of Gastroenterology and Hepatology
- Weill Cornell Medical College
- Professor of Clinical Medicine, Columbia University College of Physicians & Surgeons
Hepatitis D virus (HDV) infection is uncommon in the United States. Less than 3 percent of patients with acute hepatitis B virus (HBV) infection are coinfected with HDV. Based on studies conducted more than 20 years ago, it was estimated that approximately 70,000 Americans are chronic carriers of HDV and that as many as 1000 die of HDV-related liver disease each year . These data have not been updated.
The clinical course of infection with HDV, which generally occurs only in patients coinfected with HBV, is highly variable [1,2]. As an example, although coinfection with HDV and HBV usually causes self-limited acute hepatitis, a high incidence of fulminant hepatic failure has been reported among intravenous drug users . Similarly, superinfection of HDV in HBV carriers may be clinically inapparent or it may manifest as an exacerbation of preexisting chronic hepatitis with rapid progression to cirrhosis .
Since medical management of HDV-related liver disease has limited efficacy, some patients will require liver transplantation [4,5]. A 1995 annual report estimated that only a minority (10 to 20 percent) of the approximately 100 liver transplantations performed annually in the United States for HBV-related liver failure are in patients with concomitant HDV infection .
This topic will review hepatitis D virus reinfection following liver transplantation. The pathogenesis, clinical manifestations, prevention, and treatment of HDV infection are discussed separately (see "Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection" and "Treatment and prevention of hepatitis D virus infection").
TYPES AND RATES OF REINFECTION
Reinfection with hepatitis D virus (HDV) alone following liver transplantation is usually short-lived and not associated with recurrent liver disease unless hepatitis B virus (HBV) reinfection occurs subsequently. However, HDV reinfection can occur in the absence of markers of HBV reinfection, an observation that has provided important insights into the biology of HDV replication and the pathogenesis of HDV-related liver disease.
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- TYPES AND RATES OF REINFECTION
- DIAGNOSIS OF REINFECTION
- CLINICAL COURSE OF HDV REINFECTION
- HDV reinfection without evidence of HBV reinfection
- HDV reinfection followed by HBV reinfection
- Simultaneous HDV and HBV reinfection
- OUTCOMES OF PATIENTS TRANSPLANTED FOR HEPATITIS D
- PREVENTION OF HDV REINFECTION
- TREATMENT OF HDV REINFECTION
- SUMMARY AND RECOMMENDATIONS