HBV carriers presenting variant ESR1 have an extremely aggressive clinical course.[13,17] Since variant ESR1 isoform predominates and sometimes becomes the only form expressed in the liver with endstage liver diseases, variant forms of ESR1 may be one of the possible mechanisms underlying the fact that c.453-397 T > C genetic variation influences susceptibility to HBV-ALF. Here, ESR1 is linked to liver disorder.