Shapira Rivka, Daudi Nilli, Klein Athallia, Shouval Daniel, Mor Eytan, Tur-Kaspa Ran, Dinari Gavriel, Ben-Ari Z
Pediatric Gastroenterology Institute, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Transplantation. 2002 Mar 15;73(5):820-2. doi: 10.1097/00007890-200203150-00030.
There is very little information about hepatitis B virus (HBV) infection in children after liver transplantation. This is the first report of the addition of famciclovir in a child who developed lamivudine resistance.A 5-year-old boy who was serum HBsAg-negative and was not vaccinated against HBV underwent living-related liver transplantation for fulminant hepatitis A. The donor was his mother, who was serum HBcAb-positive. No immunoprophylaxis was administered. HBV infection developed after 18 months and was treated with 3 mg/kg daily of lamivudine. Serum alanine aminotransferase normalized and HBV DNA load decreased significantly. Sixteen months later, lamivudine resistance developed; a mutation (M552I) was confirmed by sequencing through the YMDD locus of the HBV polymerase gene. The addition of 750 mg daily of famciclovir led to seroconversion and the disappearance of serum HBV DNA. Lamivudine in combination with famciclovir might be a therapeutic option for HBV reinfection after liver transplantation, also in children. Suppression of viral replication to undetectable values is possible even in the lamivudine-resistant mutant.
关于肝移植术后儿童感染乙肝病毒（HBV）的信息非常少。本文首次报道了一名对拉米夫定产生耐药的儿童加用泛昔洛韦的情况。一名5岁男孩血清HBsAg阴性且未接种乙肝疫苗，因暴发性甲型肝炎接受了亲属活体肝移植。供体是他的母亲，其血清HBcAb阳性。未进行免疫预防。18个月后发生HBV感染，给予每日3mg/kg拉米夫定治疗。血清丙氨酸转氨酶恢复正常，HBV DNA载量显著下降。16个月后，出现拉米夫定耐药；通过对HBV聚合酶基因的YMDD位点进行测序确认了一个突变（M552I）。加用每日750mg泛昔洛韦后实现了血清学转换，血清HBV DNA消失。拉米夫定联合泛昔洛韦可能是肝移植术后HBV再感染的一种治疗选择，对儿童同样适用。即使对于拉米夫定耐药突变体，也有可能将病毒复制抑制到检测不到的水平。
