Data Sheet 1_Case Report: Unexpected HBV reactivation upon nucleos(t)ide analogue discontinuation despite 17 years of sustained HBsAg loss post-liver transplantation.pdf

In October 2022, an asymptomatic elevation of hepatic transaminases was noted, though HBV-specific virological assessments were omitted. By March 2023, further evaluation of persistent transaminase elevation confirmed robust HBV reactivation: HBV DNA surged to 5.10 × 10⁸ IU/mL, accompanied by HBeAg positivity and a quantitative HBsAg level of 98,008 IU/mL (Abbott Architect assay). Salvage therapy comprising ETV and tenofovir alafenamide (TAF) was promptly initiated, yielding rapid virological suppression and biochemical normalization.

HBV DNA fell below the lower limit of detection (<20 IU/mL) within 9 months of retreatment (December 2023) and has remained fully suppressed through April 2026. This case emphasizes that fulminant HBV reactivation may transpire following NA cessation in LT recipients, irrespective of protracted virological suppression and stable HBsAg seroclearance. This trajectory reinforces the paradigm that HBsAg loss in the context of chronic immunosuppression reflects functional viral control rather than complete viral eradication.

In concordance with major hepatology guidelines, indefinite NA prophylaxis should remain the cornerstone of management for LT recipients with HBV-related disease, precluding routine drug withdrawal.</p>