Recurrence of clinically significant hepatitis A following liver transplantation for fulminant hepatitis A

BackgroundWe report hepatitis A virus (HAV) infection of a liver allograft following transplantation for fulminant liver failure due to HAV infection. This rare condition has been described in only three patients to date. After liver transplantation allograft function was good, but starting 80 days after transplantation, episodes of acute graft dysfunction were observed.ObjectivesTo elucidate the reason for acute hepatic dysfunction a large number of differential diagnoses were tested.ResultsHAV RNA was undetectable for more than 80 days after transplantation. Detection of genomic HAV RNA by RT-PCR in serum and stool at the time of graft dysfunction led to the diagnosis of recurrent HAV infection.ConclusionsWe suggest that the risk of HAV reinfection after liver transplantation may be far higher than expected as results may be misinterpreted as rejection episodes.