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Response to Lamivudine‐Resistant Hepatitis B Virus Infection Postliver Transplantation from a Hepatitis B Core Antibody Donor

We would like to respectfully respond to the comments of Dr. Hans Tillmann. We appreciate his interest in our case report and review. We would like to clarify that we do not believe that the liver initially harbored a lamivudine-resistant mutant, but that the mutation occurred during prolonged lamivudine exposure leading to de novo breakthrough hepatitis B virus infection. There is no reason to suspect the donor already had a lamivudine-resistant mutation, otherwise the recipient should have developed acute hepatitis B at a much earlier period due to the lack of protection by lamivudine and loss of anti-HBs after 6 months. Hepatitis B virus infection from a source other than the graft would also be very unlikely. Retrospective analysis of our cohort of 402 recipients (including the reported case), receiving 467 liver transplants between March 1998 and December 2001, revealed three cases of de novo Hepatitis B (0.6%) after a median follow up of 4.5 years (1).