Kranz Birgitta, Vester Udo, Bonzel Klaus-Eugen, Paul Andreas, Gerken Guido, Hoyer Peter F
Clinic of Pediatric Nephrology, University Clinic Essen, Essen, Germany.
Pediatr Transplant. 2006 May;10(3):384-9. doi: 10.1111/j.1399-3046.2005.00482.x.
Renal transplantation in patients with chronic hepatitis B virus (HBV) infection is known to be associated with an increased risk for exacerbation of liver dysfunction. Lamivudine has been proven to be a potent inhibitor of hepatitis B virus replication in adults after kidney transplantation. Little is known about its efficacy and safety in pediatric renal transplant recipients. Three cases serve for the discussion to demonstrate the complexity of the clinical course and effective treatment of chronic hepatitis B in pediatric patients awaiting renal transplantation. Two patients on dialysis with a high HBV replication rate were treated with lamivudine before transplantation. After the viral load had decreased below the detection limit, they underwent transplantation successfully. Despite intensified immunosuppression to treat a rejection episode in one and a relapse of the nephrotic syndrome in the other patient, the viral load remained <2.5 pg/mL. Both patients developed a mutation in the YMDD motif of the HBV genome associated with an increase in the HBV replication rate >10,000 pg/mL without deterioration of the liver function. In a third patient with a chronic HBV infection with a low replication rate, lamivudine was started about nine months after kidney transplantation due to an increasing viral load after treatment of an acute rejection episode. Six months later, the HBV DNA was no longer detectable. The patient had no signs of liver dysfunction. Lamivudine in the treatment of chronic HBV infection in pediatric renal recipients seems to be safe and effective in preventing acute liver deterioration. Three clinical cases are discussed with regard to current options in monitoring and antiviral treatment of chronic HBV in pediatric renal transplant recipients.
已知慢性乙型肝炎病毒（HBV）感染患者进行肾移植与肝功能恶化风险增加有关。拉米夫定已被证明是成人肾移植后乙型肝炎病毒复制的有效抑制剂。关于其在小儿肾移植受者中的疗效和安全性知之甚少。本文通过三个病例讨论，以展示等待肾移植的小儿患者慢性乙型肝炎临床病程的复杂性及有效治疗方法。两名透析患者HBV复制率高，在移植前接受拉米夫定治疗。病毒载量降至检测限以下后，他们成功接受了移植。尽管其中一名患者因排斥反应加强了免疫抑制治疗，另一名患者肾病综合征复发，但病毒载量仍<2.5 pg/mL。两名患者均出现HBV基因组YMDD基序突变，HBV复制率增加>10,000 pg/mL，但肝功能未恶化。第三名慢性HBV感染且复制率低的患者，在肾移植约九个月后，因急性排斥反应治疗后病毒载量增加开始使用拉米夫定。六个月后，HBV DNA不再可检测到。该患者无肝功能异常迹象。拉米夫定治疗小儿肾移植受者慢性HBV感染似乎在预防急性肝功能恶化方面是安全有效的。本文讨论了三个临床病例，涉及小儿肾移植受者慢性HBV监测和抗病毒治疗的当前选择。
