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Week 7

HBV & HEV – Discussion
04
Mar
32
Posted in: Post-transplant Long-term Complications , Week 7 ,
IV. Chronic hepatitis E after kidney transplantation with an antibody response suggestive of reinfection: a case report
04
Mar
103

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Posted in: Post-transplant Long-term Complications , Week 7 ,
III. Guidelines for Hepatitis E & Solid Organ Transplantation
04
Mar
87

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Posted in: Post-transplant Long-term Complications , Week 7 ,
II. Guidelines for Hepatitis B & Solid Organ Transplantation
04
Mar
92

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Posted in: Post-transplant Long-term Complications , Week 7 ,
I. Diagnosis of hepatitis B
04
Mar
116

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Posted in: Post-transplant Long-term Complications , Week 7 ,
5. A 24-years old CKD 5 received a kidney from his brother 8 months ago. 111 mismatch, no DSA and negative FCXM. He is on CNI-based double immunosuppression with excellent kidney function. His EBV viral load increased from 200 copies/ml prior to the operation rose to 740 copies/ml 6 months after transplantation.
04
Mar
226

What is the role of EBV monitoring in this scenario? How do you manage this case?

Posted in: Post-transplant Long-term Complications , Week 7 ,
4. You were offered kidneys from a 53-year-old male DBD (donor after brain stem death) donor who suffered from SAH (grade 5) complicating cerebral aneurysm. His retrieval S Cr was 78 µmol/L. Virology was reported as follows: HBsAg positive, HBsAb negative, HBcAb negative, both HBeAg and HBeAb are negative. Both HCV and HIV are negative.
04
Mar
156

Will you accept this DBD donor? Will you accept this donor as a live donor if the recipient is also HBsAg positive? If yes, what are the conditions that should be met? Assume both HBeAg and HBeAb are positive in addition to positive HBsAg. Will this change your management? What is your differential diagnosis? How […]

Posted in: Post-transplant Long-term Complications , Week 7 ,
3. You were offered kidneys from a 59-year-old male DBD (donor after brain stem death) donor who suffered from SAH (grade 5) complicating cerebral aneurysm. His retrieval S Cr was 72 µmol/L. Virology was reported as follows: HBsAg negative, HBsAb negative, HBcAb positive, and both HBeAg and HBeAb are negative. Both HCV and HIV are negative.
04
Mar
135

Will you accept this DBD donor? Will you accept this donor as a live donor if the recipient is also HBcAb positive? If yes, what are the conditions that should be met?

Posted in: Post-transplant Long-term Complications , Week 7 ,
2. An 18-year-old lady with CKD 5 due to an unknown cause underwent living-related donor kidney transplantation in 2013. She was given a short course of steroids (discontinued 1 week after transplantation), MMF, and tacrolimus. Pre-transplant serum EBV- and CMV-IgG were negative. The donor was seronegative for CMV but positive for EBV. Kidney transplantation was uncomplicated, with a stable kidney function (eGFR varied between 92 and 98 mL/min). Six months after transplantation, serum aminotransferase levels (ALT: 66 U/L; AST: 47 U/L) were found to be slightly elevated. CMV and EBV PCRs were negative. Four weeks later, liver enzymes decreased (ALT: 53 U/L; AST: 42 U/L) to near-normal levels. Six weeks thereafter, liver enzymes (ALT: 75 U/L; AST: 58 U/L) were again found to be elevated. HCV and HBV PCR were negative.
04
Mar
152

What is your differential diagnosis? How would you manage this case?

Posted in: Post-transplant Long-term Complications , Week 7 ,
1. A 35-year-old patient with CKD5 due to HUS underwent a DBD kidney transplantation in October 2008. He was on prednisolone, MMF, and tacrolimus. During the first 1.5 years after transplantation, he developed CMV reactivation, primary EBV infection, and BK-virus viremia. Almost 3 years after transplantation at a routine check-in 2011, ALT (94 U/L) and AST (55 U/L) were found to be elevated. Kidney function was stable with an eGFR of 80 mL/min. Liver enzymes remained slightly increased in 2012 and 2013. No clear relation could be found with drugs. HCV and HBV PCR were negative. Repeated testing for BK, EBV and CMV DNA was negative. After temporary normalization, liver enzymes increased again with an ALT of 117 U/L. At that point, HEV PCR was performed, and the result was positive. Genotyping of the virus revealed the presence of HEV genotype 3. Retrospectively, archived blood samples were analysed for the presence of HEV RNA and for anti-HEV IgG and IgM serology. Anti-HEV IgM was positive and IgG negative in the first HEV RNA–positive sample in 2011; later, anti-HEV IgG also became positive.
04
Mar
171

How would you manage this case? What is the prevalence of HEV in solid organ transplantation?

Posted in: Post-transplant Long-term Complications , Week 7 ,
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