Course of hepatitis delta virus infection in auxiliary liver grafts in patients with delta virus cirrhosis.

Two patients, with decompensated liver cirrhosis due to a chronic hepatitis type D, received an auxiliary partial liver graft. Both grafts were infected by hepatitis B and D virus. The appearance of hepatitis B and D antigens in the graft were investigated in serial liver biopsies in relation to light microscopical and biochemical changes. One week after transplantation HDAg could already be demonstrated in 1-50 percent of hepatocytic nuclei, in one graft combined with HBsAg along the cell membranes. In the three-week biopsies the expression of HBsAg had increased. After 7-9 weeks both grafts showed biochemical and histological evidence of an acute hepatitis; at that time HBcAg and HBeAg had appeared in the nucleus and cytoplasm of many hepatocytes. Thereafter HBcAg and HBeAg expression in the liver tissue decreased slowly, and acute hepatitis transformed into chronic hepatitis. Two and three years after transplantation both grafts showed good function, with only minimal fibrosis in one and severe fibrosis in the other. HDAg and HBsAg expression persisted, while HBc and HBeAg disappeared in the one with minimal fibrosis and decreased in the other. It is concluded that the course of HBV with HDV co-infection in liver grafts includes an excellent medium-term prognosis.