Acute Liver Failure Due to Discontinuation of Hepatitis B Virus (HBV) Therapy

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Encouraging patients to continue taking antiviral treatment to prevent acute on chronic relapse of HBV is extremely important. We present a case of an elderly male with acute liver failure leading to liver transplantation as a result of discontinuing HBV therapy. Case Description/Methods: A 70-year old man with chronic HBV and cirrhosis presents with nausea. The patient was virally suppressed for several years on lamivudine but switched to tenofovir due to viral breakthrough. For 8 months, the patient has been off of all antivirals, due to loss of health insurance after retirement. Within 3 months, the patient develops jaundice, nausea, loss of appetite, a 15-pound weight loss and dark urine. Labs show hyperbilirubinemia (51.7) and elevated alanine transaminase and aspartate aminotransferase (349 and 320), creatinine of 1.75, international normalized ratio of 2.11, along with HBV panel showing acute infection. Repeat labs during a hepatology visit show worsening renal function indicative of a kidney injury, and the patient is recommended to start entecavir 1g daily for hepatitis treatment while a pre-transplant evaluation and consultation is initiated. Given a model for end-stage liver disease score of 41, the patient is listed for liver transplant. The patient undergoes a donation after cardiac brain death orthotopic liver transplantation two weeks later and is placed on mycophenolate, tacrolimus and steroid immunosuppression along with antimicrobial and antifungal prophylactic therapies. The patient is discharged one week after surgery on entecavir, along with immunosuppression regimen of tacrolimus, prednisone and mycophenolate. The patient is readmitted twice for acute on chronic renal insufficiency, which resolves after starting intravenous fluids. After these episodes, mycophenolate dosage is decreased and everolimus is initiated for renal sparing immunosuppressive therapy. At 1 and a half years post-transplant, his renal function is improved, but is classified as chronic kidney disease stage IV. He continues to follow up with nephrology in order to monitor his progress. Discussion: It is important for providers to ensure that chronic HBV patients continue to take their antivirals. Providers should educate patients on the risks of stopping medication and the devastating consequences of viral breakthrough. Additional patient education on how to approach lapses in health insurance may also be helpful in these cases.

Volume

118

Issue

10

First Page

S2355

Last Page

S2356

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