Raheem Omer A, Hickey David P
Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
Arab J Nephrol Transplant. 2013 Jan;6(1):41-4.
Risk of reactivation of Hepatitis B virus (HBV) infection and other liver related complications continues to be a major cause of concern in HBV carriers undergoing cadaveric renal transplantation. Antiviral medications have been recommended post renal transplantation in patients who are chronic HBV carriers.
Here we present the case of a 15-year-old girl known to have kidney failure and chronic active HBV infection indicated by positivity of both HBsAg and HBeAg. She was treated with interferon alpha for six months resulting in clearance of HBeAg and reduction of HBV-DNA titer to 32.15 copies/ml. She underwent successful cadaveric renal transplantation and was maintained on cyclosporine, azathioprine and prednisolone. Two years post transplant, the patient developed elevated liver enzymes, positive HBeAg and high HBV-DNA titers. She was treated with lamivudin resulting in normalization of liver function tests. Lamivudine was discontinued after nine months due to poor compliance resulting from psychological problems. Three years post transplant, the patient was started on Entecavir 0.5 mg oral, daily. At follow up clinic visits till present time, the patient is tolerating Entecavir treatment with no reported side effects. Liver enzymes remained stable, but the effect on viral load and viral markers was unremarkable.
The role of various antiviral agents in treating HBV infection among kidney transplant recipients requires further evaluation.
在接受尸体肾移植的乙肝病毒（HBV）携带者中，HBV感染再激活的风险以及其他肝脏相关并发症仍然是主要的关注原因。对于慢性HBV携带者患者，肾移植后推荐使用抗病毒药物。
在此，我们报告一例15岁女孩的病例，她已知患有肾衰竭且慢性HBV感染，表现为HBsAg和HBeAg均呈阳性。她接受了6个月的α干扰素治疗，结果HBeAg清除，HBV-DNA滴度降至32.15拷贝/毫升。她成功接受了尸体肾移植，并接受环孢素、硫唑嘌呤和泼尼松龙治疗。移植后两年，患者出现肝酶升高、HBeAg阳性和高HBV-DNA滴度。她接受了拉米夫定治疗，肝功能检查结果恢复正常。由于心理问题导致依从性差，9个月后停用拉米夫定。移植后三年，患者开始每日口服0.5毫克恩替卡韦。在直至目前的随访门诊中，患者耐受恩替卡韦治疗，未报告有副作用。肝酶保持稳定，但对病毒载量和病毒标志物的影响不显著。
各种抗病毒药物在治疗肾移植受者HBV感染中的作用需要进一步评估。
