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A coroner has raised concerns over a lack of national guidance on prescribing and monitoring for hepatitis B reactivation, following the death of a patient.
In a ‘Prevention of future deaths’ report‘, published online on 10 July 2026, Richard Brittain, assistant coroner for Inner London North, stated that patient Tung Tran, aged 41 years, died from complications from reactivation of hepatitis B, “which arose from inadvertent discontinuation of necessary medical treatment”.
Tran had a renal transplant in 2013 and was diagnosed with chronic hepatitis B during the process, the coroner wrote.
The patient was later discharged from hepatology and continued to receive viral reactivation prophylaxis entecavir from renal transplant services.
“Supply of medication changed to home delivery in early 2025 but the entecavir was inadvertently discontinued, as there was a presumption that hepatology would continue to prescribe this. Mr Tran appears to have understood this to have been an intentional change of his medication,” the coroner said.
“He attended his local hospital in August 2025 with signs of acute liver disease from reactivation of hepatitis B and was transferred to the Royal Free Hospital. He was too unwell to be considered for liver transplant and sadly died on 12 September 2025.”
Directing a concern over the risk of future deaths to the British Viral Hepatitis Group at the British Association for the Study of the Liver (BASL), the coroner noted: “There is a lack of national guidance regarding which services should be responsible for the monitoring and prescribing in relation to hepatitis B reactivation prevention.”
He also directed a concern to the UK Health Security Agency that there is a “large population” of patients who have been found to have hepatitis B through opt-out screening in emergency departments, “but there is a lack of specialised commissioning to maintain subsequent engagement with services”.
“I heard that this differs from the position with regards to hepatitis C and HIV services, even though these patient populations are smaller,” the coroner added.
In its response to the report, sent on 6 July 2026, the BASL said: [The BASL] does not lead the development or publication of clinical guidelines.”
Patients with chronic hepatitis B are “usually managed in specialist hepatology services and the responsibility of monitoring and prescribing lies with these services”, it added.
The BASL continued that for patients at risk of reactivation of hepatitis B, guidance on antiviral therapy is provided by “the relevant specialist societies and also in local NHS trust guidance”.
“There is variation between NHS trusts as to whether this monitoring and prescribing is delivered by the treating team or whether specialist hepatology services are involved,” it said.
Read more: Hepatitis B — prevention, diagnosis and management
