Jamal H, Regenstein F, Farr G, Perrillo R P
Section of Gastroenterology and Hepatology, Alton Ochsner Medical Institutions, New Orleans, Louisiana, USA.
Am J Gastroenterol. 1996 May;91(5):1027-30.
A 45-yr-old man underwent liver transplantation for cirrhosis due to hepatitis B and developed recurrent infection. Serial liver biopsies revealed fibrosing cholestatic hepatitis, an entity that is associated with rapid graft failure, and this was treated with long-term intravenous ganciclovir therapy. The patient is alive and well 2 yr after transplantation, despite the presence of well-established cirrhosis and a marked accumulation of intrahepatic hepatitis B surface and core antigens. It is postulated that partial reduction of viral replication resulted in an incomplete syndrome in which rapid graft failure did not occur, but progressive fibrosis developed. Our case suggests that newer nucleoside analogues that provide a greater degree of inhibition to hepatitis B virus replication may greatly improve the outcome of patients with recurrent infection after liver transplantation.
一名45岁男性因乙型肝炎肝硬化接受了肝移植，并发生了反复感染。系列肝活检显示为纤维性胆汁淤积性肝炎，这是一种与移植物快速衰竭相关的病症，对此采用了长期静脉注射更昔洛韦治疗。尽管存在已确诊的肝硬化以及肝内乙型肝炎表面抗原和核心抗原的显著蓄积，但该患者在移植后2年仍存活且状况良好。据推测，病毒复制的部分减少导致了一种不完全综合征，其中未发生移植物快速衰竭，但出现了进行性纤维化。我们的病例表明，对乙型肝炎病毒复制具有更大抑制程度的新型核苷类似物可能会大大改善肝移植后反复感染患者的预后。
