Taltavull Teresa C, Chahri Nadia, Verdura Blanca, Gornals Joan, Lopez Carmen, Casanova Aurora, Cañas Concha, Figueras Juan, Casais Luis A
Liver Transplant Unit, Hospital Universitari de Bellvitge, Barcelona, Spain.
Transpl Int. 2005 Jul;18(7):879-83. doi: 10.1111/j.1432-2277.2005.00125.x.
Antiviral treatment can be complex in decompensated hepatitis B virus (HBV) cirrhosis because of potential emergence of lamivudine-resistant mutants and worsening liver function, and to multifactorial nephrotoxicity. Negative HBV-DNA status by hybridization before liver transplantation is a favorable prognostic factor. We present the case of a 54-year-old HBV+ liver transplantation candidate who, after testing negative for HBV-DNA, developed YMDD lamivudine-resistant mutants resulting in a deteriorated clinical condition. After 8 months of adefovir plus lamivudine double therapy, only partial response was achieved. Tenofovir was added to this regimen, and an early decline of HBV-DNA was seen at 4 weeks without adverse events. The patient underwent transplantation. At 21-month postoperative follow-up, the patient's outcome was excellent. Post-transplantation HBV prophylaxis, taking into account the prior development of mutants, consists of hepatitis B immunoglobulin plus lamivudine and adefovir. Tenofovir was well tolerated and produced a fast antiviral response, suggesting its potential value in combined antiviral treatment for liver transplantation candidates.
对于失代偿期乙型肝炎病毒（HBV）肝硬化患者，抗病毒治疗可能较为复杂，这是因为可能会出现拉米夫定耐药突变体以及肝功能恶化，还存在多因素导致的肾毒性。肝移植前通过杂交检测显示HBV-DNA呈阴性是一个有利的预后因素。我们报告了一例54岁的HBV阳性肝移植候选者的病例，该患者在HBV-DNA检测呈阴性后，出现了YMDD拉米夫定耐药突变体，导致临床状况恶化。在接受阿德福韦加拉米夫定联合治疗8个月后，仅取得了部分缓解。在此治疗方案中加入替诺福韦后，4周时可见HBV-DNA早期下降，且无不良事件发生。该患者接受了移植手术。术后21个月的随访结果显示，患者预后良好。考虑到之前已出现突变体，移植后HBV预防措施包括乙型肝炎免疫球蛋白加拉米夫定和阿德福韦。替诺福韦耐受性良好，并产生了快速的抗病毒反应，表明其在肝移植候选者联合抗病毒治疗中具有潜在价值。
