Abstract • A patient suffering from chronic active hepatitis with macronodular cirrhosis, positive for hepatitis B surface antigen (HBsAg), was treated with an orthotopic liver allograft. The HBs antigenemia, as measured with several precipitation tests and by complement fixation, became negative after transplantation and remained so for about 2½ months. During the interval, very low titers of the antigen were detectable by radioimmunoassay. At about three months after transplantation, she had an attack of acute hepatitis, at which time HBsAg became detectable by all tests. She recovered, but progressive liver disease developed during the remaining 1½ years of her life. She died of disseminated nocardiosis and candidiasis with deteriorating hepatic function. The homograft at autopsy showed no evidence of rejection, but was the site of chronic active liver disease, although of a different pathologic pattern than that affecting her native liver. The differences in histology may reflect the influence of chronic immunosuppression on the features of chronic active hepatitis. (Arch Surg 114:75-78, 1979) References 1. Blumberg BS, Sutnick AI, London WT, et al: Current concepts, Australia antigen and hepatitis . N Engl J Med 283:349-354, 1970.Crossref 2. Starzl TE, Putnam CW: Experience in Hepatic Transplantation . Philadelphia, WB Saunders Co, 1969. 3. Starzl TE, Putnam CW, Halgrimson CG, et al: Cyclophosphamide and whole organ transplantation in humans . Surg Gynecol Obstet 133:981-991, 1971. 4. Goodman JS, Koenig MD: Nocardia infections in a general hospital . Ann NY Acad Sci 174:552-567, 1970.Crossref 5. Walsh JH, Yalow RS, Berson SA: Detection of Australia antigen and antibody by means of radioimmunoassay techniques . J Infect Dis 121:550-554, 1970.Crossref 6. Torisu M, Yokoyama T, Amemiya H, et al: Immunosuppression, liver injury, and hepatitis in renal, hepatic, and cardiac homograft recipients: With particular reference to the Australia antigen . Ann Surg 174:620-639, 1971.Crossref
Archives of Surgery – American Medical Association
Published: Jan 1, 1979
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