{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:45:25Z","timestamp":1792215925307,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Hepatitis A virus (HAV) infection is an uncommon indication for liver transplantation, and donor\u2010derived or transfusion\u2010associated HAV infection is rare. Data describing HAV recurrence or early acquisition following liver transplantation, particularly with longitudinal quantitative viral kinetics, are limited. We describe two liver transplant recipients with graft HAV infection occurring in different immunological contexts. One patient underwent emergency liver transplantation for HAV\u2010related acute liver failure and subsequently developed recurrent HAV infection of the graft. The second patient underwent liver transplantation for paracetamol\u2010induced acute liver failure and acquired HAV infection following peri\u2010operative blood transfusion in the early post\u2010transplant period. Serial qualitative and retrospective quantitative HAV ribonucleic acid (RNA) polymerase chain reaction (PCR) measurements were analysed alongside biochemical and clinical parameters. In the patient transplanted for fulminant HAV infection, serum HAV RNA declined rapidly after transplantation, consistent with removal of the infected native liver, followed by recurrent viraemia associated with graft hepatitis during the second and third post\u2010transplant months, and with viral clearance by 4\u2009months. In contrast, the transfusion\u2010acquired HAV infection occurred in the setting of profound immunosuppression and absence of pre\u2010existing immunity, resulting in a higher peak viral load, prolonged viraemia lasting over 9\u2009months, and more severe graft hepatitis. Viral doubling times during viraemic expansion were similar in both cases but sustained high\u2010level viraemia was observed only in the de novo infection. These cases provide novel insights into HAV viral kinetics following liver transplantation and highlight important differences between recurrent infection and newly acquired HAV infection in immunosuppressed recipients.<\/jats:p>","DOI":"10.1111\/jvh.70248","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:30:31Z","timestamp":1792215031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hepatitis A Virus (\n                    <scp>HAV<\/scp>\n                    ) Recurrence and De Novo Hepatitis A Acquired at Time of Liver Transplantation: Comparison of Graft\n                    <scp>HAV<\/scp>\n                    Infection and Viral Kinetics"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6648-7446","authenticated-orcid":false,"given":"David","family":"Mutimer","sequence":"first","affiliation":[{"name":"Liver and Hepatobiliary Unit, Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"},{"name":"Institute of Immunology and Immunotherapy College of Medical and Dental Sciences, University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0548-8957","authenticated-orcid":false,"given":"Elinor","family":"Latham","sequence":"additional","affiliation":[{"name":"Blood Borne Virus Unit United Kingdom Health Security Agency (UKHSA)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-8477","authenticated-orcid":false,"given":"Sowsan F.","family":"Atabani","sequence":"additional","affiliation":[{"name":"United Kingdom Health Security Agency (UKHSA) Specialized Microbiology and Laboratories, Southwest  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samreen","family":"Ijaz","sequence":"additional","affiliation":[{"name":"Blood Borne Virus Unit United Kingdom Health Security Agency (UKHSA)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_7_2_1","article-title":"Laboratory Reports of Hepatitis A Infections in England and Wales: 2024","volume":"19","author":"UK Health Security Agency","year":"2025","journal-title":"Health Protection Report"},{"key":"e_1_2_7_3_1","article-title":"Hepatitis A: An Epidemiological Survey in Blood Donors, France 2015 to 2017","volume":"23","author":"Gallian P.","year":"2018","journal-title":"Euro Surveillance"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/trf.17225","article-title":"Hepatitis A Virus RNA Detection in Polish Blood Donors and Likely Transmissions Through Blood Components During the 2017\u20132019 Epidemic","volume":"63","author":"Sulkowska E.","year":"2023","journal-title":"Transfusion"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jcv.2005.08.005","article-title":"Recurrence of Clinically Significant Hepatitis A Following Liver Transplantation for Fulminant Hepatitis A","volume":"35","author":"Eisenbach C.","year":"2006","journal-title":"Journal of Clinical Virology"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"590","DOI":"10.3201\/eid2304.161532","article-title":"Transmission of Hepatitis A Virus Through Combined Liver\u2010Small Intestine\u2010Pancreas Transplantation","volume":"23","author":"Foster M. A.","year":"2017","journal-title":"Emerging Infectious Diseases"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/jmv.1890300210","article-title":"Persistence of Hepatitis A Virus in Fulminant Hepatitis and After Liver Transplantation","volume":"30","author":"Fagan E.","year":"1990","journal-title":"Journal of Medical Virology"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/jmv.1890450107","article-title":"Clinical Recurrence of Hepatitis A Following Liver Transplantation for Acute Liver Failure","volume":"45","author":"Gane E.","year":"1995","journal-title":"Journal of Medical Virology"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/hep.1840130122","article-title":"Hepatic Histological Findings After Transplantation for Chronic Hepatitis B Infection, Including a Unique Pattern of Fibrosing Cholestatic Hepatitis","volume":"13","author":"Davies S. E.","year":"1991","journal-title":"Hepatology"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1002\/hep.510230505","article-title":"Severe Recurrent Cholestatic Hepatitis C Following Orthotopic Liver Transplantation","volume":"23","author":"Schluger L. K.","year":"1996","journal-title":"Hepatology"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/lt.24349","article-title":"Effect of Scavenger Receptor Class B Type 1 Antagonist ITX5061 in Patients With Hepatitis C Infection Undergoing Liver Transplantation","volume":"22","author":"Rowe I. A.","year":"2016","journal-title":"Liver Transplantation"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/j.1600-6143.2006.01255.x","article-title":"Pegylated Interferon Alpha\u20102b for Patients With HCV Recurrence and Graft Fibrosis Following Liver Transplantation","volume":"6","author":"Heydtmann M.","year":"2006","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/S0168-8278(99)80204-9","article-title":"High Pre\u2010Treatment Serum Hepatitis B Titre Predicts Failure of Lamivudine Prophylaxis and Graft Re\u2010Infection After Liver Transplantation","volume":"30","author":"Mutimer D.","year":"1999","journal-title":"Journal of Hepatology"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010026\u201052234\u2010y"},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1097\/HEP.0000000000001762","article-title":"Two Decades of Hepatitis E in Solid Organ Transplantation: A Retrospective Monocentric Analysis","volume":"84","author":"Kamar N.","year":"2026","journal-title":"Hepatology"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/hep.30262","article-title":"A Model to Predict 1\u2010Month Risk of Transplant or Death in Hepatitis A\u2010Related Acute Liver Failure","volume":"70","author":"Kim J. D.","year":"2019","journal-title":"Hepatology"},{"key":"e_1_2_7_17_1","first-page":"67","article-title":"Effect of Ribavirin on Hepatitis A Virus Replication In\u00a0Vitro","volume":"3","author":"Chaudhary R. K.","year":"1992","journal-title":"Canadian Journal of Infectious Diseases"},{"key":"e_1_2_7_18_1","first-page":"512","article-title":"Efficacy of Telaprevir\u2010Based Therapy in Stable Liver Transplant Patients With Chronic Genotype 1 Hepatitis C","volume":"15","author":"Forns X.","year":"2016","journal-title":"Annals of Hepatology"},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(16)00052-9","article-title":"Ledipasvir and Sofosbuvir Plus Ribavirin in Patients With Genotype 1 or 4 Hepatitis C Virus Infection and Advanced Liver Disease: Multicentre. Open Label, Randomised, Phase 2 Trial","volume":"16","author":"Manns M.","year":"2016","journal-title":"Lancet Infectious Diseases"},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1086\/315701","article-title":"Duration of Viraemia in Hepatitis A Infection","volume":"182","author":"Bower W. A.","year":"2000","journal-title":"Journal of Infectious Diseases"},{"key":"e_1_2_7_21_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1046\/j.1365-2893.2002.00336.x","article-title":"Quantification and Duration of Viraemia During Hepatitis A Infection as Determined by Real\u2010Time RT\u2010PCR","volume":"9","author":"Costa\u2010Mattioli M.","year":"2002","journal-title":"Journal of Viral Hepatitis"},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/jmv.21958","article-title":"Hepatitis A Viral Load Reduction in Relation to Severity of the Infection","volume":"83","author":"Fujiwara K.","year":"2011","journal-title":"Journal of Medical Virology"},{"key":"e_1_2_7_23_1","doi-asserted-by":"crossref","first-page":"4683","DOI":"10.3748\/wjg.v12.i29.4683","article-title":"Virological Course of Hepatitis A Virus as Determined by Real\u2010Time RT\u2010PCR: Correlation With Biochemical, Immunological and Genotypic Profiles","volume":"12","author":"Hussain Z.","year":"2006","journal-title":"World Journal of Gastroenterology"},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1111\/j.1440-1746.2005.03908.x","article-title":"Influence of Load of Hepatitis A Virus on Disease Severity and Its Relationship With Clinical Manifestations","volume":"20","author":"Sainokami S.","year":"2005","journal-title":"Journal of Gastroenterology and Hepatology"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"2817","DOI":"10.3201\/eid2711.20462","article-title":"Hepatitis A Virus Incidence Rates and Biomarker Dynamics in Plasma Donors, United States","volume":"27","author":"Schoch S.","year":"2021","journal-title":"Emerging Infectious Diseases"},{"key":"e_1_2_7_26_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/jmv.10163","article-title":"Prolonged Hepatitis A Infection in an HIV\u20101\u2010Seropositive Patient","volume":"68","author":"Costa\u2010Mattioli M.","year":"2002","journal-title":"Journal of Medical Virology"},{"key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1086\/338152","article-title":"Influence of Human Immunodeficiency Virus Type 1 on Acute Hepatitis A Infection","volume":"34","author":"Ida S.","year":"2002","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_7_28_1","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1093\/cid\/ciy328","article-title":"Less Severe but Prolonged Course of Acute Hepatitis A in HIV\u2010Infected Patients Compared With HIV\u2010Uninfected Patients During an Outbreak","volume":"67","author":"Lee Y. L.","year":"2018","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_7_29_1","doi-asserted-by":"crossref","DOI":"10.1097\/TXD.0000000000001506","article-title":"Donor\u2010Derived Transmission of Hepatitis A Virus Following Kidney Transplantation","volume":"9","author":"Jones J. M.","year":"2023","journal-title":"Transplantation Direct"},{"issue":"3","key":"e_1_2_7_30_1","article-title":"Rare Case of Donor Transmission of Hepatitis A Virus in 2 Kidney Transplant Recipients","volume":"20","author":"Kumar A.","year":"2020","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_7_31_1","doi-asserted-by":"crossref","DOI":"10.1111\/tid.13857","article-title":"Hepatitis A Transmission to Two Kidney Transplant Recipients From a Shared Donor","volume":"24","author":"Werenski H. E.","year":"2022","journal-title":"Transplant Infectious Disease"},{"key":"e_1_2_7_32_1","unstructured":"NHS Blood and TransplantandUK Health Security Agency Epidemiology Unit \u201cSafe Supplies 2023: Close Monitoring of Blood Donations \u201d(2024) https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco\u2010assets\u2010corp\/34404\/safe\u2010supplies\u20102023\u2010annual\u2010review\u2010final.pdf."}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.70248","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jvh.70248","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.70248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T05:30:36Z","timestamp":1792215036000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.70248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":31,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/jvh.70248"],"URL":"https:\/\/doi.org\/10.1111\/jvh.70248","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"value":"1352-0504","type":"print"},{"value":"1365-2893","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"2026-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70248"}}