Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
Department of Thoracic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
BMJ Case Rep. 2023 Oct 10;16(10):e255663. doi: 10.1136/bcr-2023-255663.
A man in his 40s was diagnosed with interstitial pneumonia at another hospital. He was referred to our hospital for lung transplantation. His lung function was rapidly declining, necessitating semiurgent living-donor lobar lung transplantation (LDLLT). Although he was negative for hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb), one of the candidate donors was proven HBsAg-positive. The risk of hepatitis B virus (HBV) infection at transplantation was considered high; however, after careful discussion about the safety of the recipient and donor, it was decided to conduct LDLLT. For prophylaxis, human anti-HBV surface immunoglobulin and entecavir were administered to the recipient. HBsAg and HBsAb were continuously monitored postoperatively and consistently negative, suggesting no signs of reactivation in the recipient, even after corticosteroid pulse treatment for acute cellular rejection. More than 6 months after LDLLT, there were no signs of HBV reactivation in either the recipient or donor.
一位 40 多岁的男性在另一家医院被诊断为间质性肺炎。他被转介到我们医院进行肺移植。他的肺功能迅速下降，需要进行半紧急的活体供体肺叶移植（LDLLT）。尽管他的乙肝表面抗原（HBsAg）和乙肝表面抗体（HBsAb）均为阴性，但其中一位候选供体的 HBsAg 呈阳性。考虑到移植时乙型肝炎病毒（HBV）感染的风险较高；然而，在仔细讨论了受者和供者的安全性后，决定进行 LDLLT。为了预防，给受者注射了人抗 HBV 表面免疫球蛋白和恩替卡韦。术后持续监测 HBsAg 和 HBsAb，结果均为阴性，提示受者无 HBV 再激活迹象，即使在急性细胞排斥反应的皮质类固醇脉冲治疗后也是如此。LDLLT 后 6 个多月，受者和供者均无 HBV 再激活迹象。
