Department of General and Visceral Surgery, University Hospital of Muenster, Muenster, Germany.
Ann Hepatol. 2011 Jul-Sep;10(3):355-60.
The increasing demand for transplantation has led to consideration of liver grafts from donors exposed to hepatitis B virus (HBV). Six transplantations of liver grafts from hepatitis B surface antigen (HBsAg) positive donors have been reported; two recipients suffered from HBV/HDV (hepatitis Delta virus) coinfection and were followed up for 10-12 months. Here, we report a 56 months follow-up of a HBV/HDV-coinfected recipient of a HBsAg positive liver graft. Posttransplant combination prophylaxis consisted of hepatitis immunoglobulin, lamivudine and adefovir dipivoxil. HBsAg remained positive during stable posttransplant follow-up and subclinical HDV reinfection with low replication rate was detected at 1 month. Pegylated interferon therapy was introduced after documentation of histological evidence of mild chronic hepatitis, but without virological response after 48 weeks. Finally, antiviral treatment was switched to tenofovir disoproxil fumarate. More than 50 months posttransplant the recipient revealed clinical symptoms of decompensated liver cirrhosis and has been relisted for liver transplantation. In conclusion HBsAg positive liver grafts in HBsAg positive recipients with HDV coinfection may result in virological recurrence and rapid development of liver cirrhosis.
供体乙型肝炎表面抗原（HBsAg）阳性的肝移植需求增加，引发了人们对 HBV 供肝的考虑。已有 6 例 HBsAg 阳性供体肝移植的报道；其中 2 例受者发生 HBV/HDV（丁型肝炎病毒）共感染，随访 10-12 个月。我们报道了 1 例 HBsAg 阳性肝移植受者发生 HBV/HDV 共感染，随访 56 个月。移植后联合预防方案包括乙型肝炎免疫球蛋白、拉米夫定和阿德福韦酯。在稳定的移植后随访期间，HBsAg 持续阳性，1 个月时检测到低复制率的亚临床 HDV 再感染。在组织学证实为轻度慢性肝炎后开始使用聚乙二醇干扰素治疗，但 48 周后无病毒学应答。最终，抗病毒治疗转换为富马酸替诺福韦酯。移植后 50 多个月，受者出现失代偿性肝硬化的临床症状，并重新列入肝移植名单。综上所述，HBsAg 阳性供体肝移植给 HBsAg 阳性且 HDV 共感染的受者可能导致病毒学复发和迅速发展为肝硬化。
