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Semin Liver Dis 2009; 29(2): 233-237
DOI: 10.1055/s-0029-1216299
DIAGNOSTIC PROBLEMS IN HEPATOLOGY

© Thieme Medical Publishers

Patient with Hepatitis B and Alcoholic Liver Disease Before and After Liver Transplantation

Stephen C. Ward1 , Charissa Y. Chang2 , Lan Peng1 , Lawrence U. Liu2
  • 1The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York
  • 2Division of Liver Diseases, Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York
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Publication History

Publication Date:
22 April 2009 (online)

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ABSTRACT

We present the case of a patient with hepatitis B virus infection and alcohol use (30 g/day by self-report) who developed cirrhosis and proceeded to liver transplantation at age 49. The explanted liver showed cirrhosis with evidence of burnt-out steatohepatitis and hepatitis B virus and a 0.7-cm focus of well-differentiated hepatocellular carcinoma. He was managed following transplant with tacrolimus, prednisone, lamivudine, adefovir, and hepatitis B immune globulin infusions. His post-transplant course was complicated by several episodes of elevated liver enzymes. Liver biopsy 3 months after liver transplantation showed acute rejection and mild steatohepatitis. Liver biopsy 6 months after liver transplantation showed marked steatosis (~95%) with moderate steatohepatitis and evidence of treated rejection. Subsequent biopsies (15 and 21 months post liver transplantation) showed resolution of the steatohepatitis, but development of chronic rejection. We discuss the interaction of alcoholic liver disease and hepatitis B virus in the development of cirrhosis and hepatocellular carcinoma, as well as the role of liver transplantation in these patients.

KEYWORDS

Hepatitis B virus - alcoholic liver disease - cirrhosis - liver transplantation

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Stephen C WardM.D. Ph.D. 

Department of Pathology, The Mount Sinai Medical Center

One Gustave L. Levy Place, New York, NY 10029

Email: Stephen.Ward@mssm.edu

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