RESUMEN
We report a 66-year-old Chinese lady who presented with a three-month history of postprandial vomiting, early satiety, anorexia and weight loss, and significant physical findings of hepatomegaly and ascites. Gastroscopy revealed gastric polyposis with both hyperpigmented and unpigmented lesions over the gastric fundus, body, and proximal antrum, biopsies of which yielded malignant melanoma histologically. Cross-sectional imaging with CT also demonstrated extensive hepatic and bony metastases. No cutaneous or ocular primary was detected. She was treated with a combination of ipilimumab and nivolumab but developed interval progression of hepatic metastases after two cycles of immunotherapy. The patient eventually succumbed two months after diagnosis.
RESUMEN
The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review of the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.