Kidney transplant and cryptic hepatitis

Blood test results showed: high concen trations of ã-glutamyltranspeptidase (231 IU/L), aspartate aminotransferase (AST; 1026 IU/L), alanine amino transferase (704 IU/L), and total alkaline phosphatase (414 IU/L). Restoration of immune function, on withdrawal of immunosuppressive therapy, introduced a new imbalance between host immunity and virus infection.3 This experience has also been reported for HBV infections in HIV-infected patients after introduction of highly active antiretroviral therapy4 and in patients receiving chemotherapy for cancer.5 In our patient, it resulted in rapid immune-mediated destruction of HBVinfected hepatocytes, manifested as acute hepatitis.