Although hepatitis A virus (HAV)
infection is usually self-limited, it may induce
fulminant hepatitis. We present an unusual case of a 40-year-old, otherwise healthy man with intractable recurrent HAV
infection requiring retransplantation after primary
liver transplantation for HAV-associated
fulminant liver failure. After the first living-donor
liver transplantation, allograft function recovered uneventfully; however, beginning at 35 days, his serum total
bilirubin concentration increased, reaching 40 mg/dL, with a slight increase in liver
enzymes. Detection of genomic HAV
RNA in serum at the time of graft dysfunction led to a diagnosis of recurrent HAV
infection. Fifty-one days after the first transplant, he underwent a deceased donor retransplantation. His allograft function recovered; the patient was discharged from the hospital. Sixty-five days later, however, he was readmitted for
colitis-like symptoms and was again treated for acute rejection, but died owing to overwhelming
sepsis and persistence of HAV
infection. These findings indicate that patients who undergo
liver transplantation for HAV-associated
liver disease may be at risk of HAV
reinfection, particularly if they require anti-rejection therapy. Routine measurements of
anti-HAV immunoglobulin M and HAV
RNA during the early posttransplant period in HAV-associated
liver transplant recipients may differentiate
reinfection from an acute cellular rejection episode.