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January 1979

Liver Allograft: Its Use in Chronic Active Hepatitis With Macronodular Cirrhosis, Hepatitis B Surface Antigen

Author Affiliations

From the Department of Surgery (Drs Corman, Putnam, Iwatsuki, Schröter, and Starzl), University of Colorado Medical Center, Denver; the Department of Medicine, University of Southern California, Rancho Los Amigos Hospital, Downey (Dr Redeker); the Department of Pathology, St Mary's Hospital Medical School, London (Prof Porter); and Department of Pathology, John Wesley Hospital, Los Angeles (Dr Peters). Dr Corman is now with L'Universite de Montreal, Hopital Notre-Dame; Dr Putnam the Department of Surgery, Tucson (Ariz) Veterans Administration Hospital; and Dr Iwatsuki the Department of Surgery, Loyola University Medical Center, Maywood, Ill.

Arch Surg. 1979;114(1):75-78. doi:10.1001/archsurg.1979.01370250077016

• 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)