Al Faraidy K, Yoshida E M, Davis J E, Vartanian R K, Anderson F H, Steinbrecher U P
Department of Medicine, University of British Columbia, Vancouver, Canada.
Transplantation. 1997 Sep 27;64(6):926-8. doi: 10.1097/00007890-199709270-00024.
Fibrosing cholestatic hepatitis (FCH) is a severe form of hepatitis B virus (HBV) infection occurring as either primary allograft reinfection after liver transplantation for HBV or as severe HBV reactivation induced by immunosuppression in patients with previously latent infection. Without treatment, FCH is universally fatal within a few months of diagnosis. Some improvement has been reported with long-term ganciclovir, with and without foscarnet, but an effective and easily available treatment has not yet been reported.
We report the prolonged survival of a renal transplant recipient who developed histologically confirmed FCH 6 months after transplantation and was treated with lamivudine.
At the time of diagnosis, the patient had jaundice, ascites, and a serum HBV-DNA level of 3868 pg/ml. Lamivudine was instituted 2 months later, and after 6 months of treatment, the HBV-DNA level was undetectable with the serum bilirubin within the normal range. Twelve months after the diagnosis of FCH, the patient remains stable without progression of liver dysfunction.
Our experience demonstrates that lamivudine therapy can improve the dismal natural history of FCH.
纤维淤胆型肝炎（FCH）是乙型肝炎病毒（HBV）感染的一种严重形式，可发生于因HBV感染进行肝移植后的原发性移植肝再感染，或发生于既往潜伏感染患者因免疫抑制诱导的严重HBV再激活。未经治疗的FCH在诊断后的几个月内普遍会导致死亡。有报道称，长期使用更昔洛韦（无论是否联合膦甲酸钠）治疗有一定改善，但尚未报道有有效且易于获得的治疗方法。
我们报告了一名肾移植受者的长期存活情况，该患者在移植后6个月发生了经组织学证实的FCH，并接受了拉米夫定治疗。
诊断时，患者出现黄疸、腹水，血清HBV-DNA水平为3868 pg/ml。2个月后开始使用拉米夫定，治疗6个月后，HBV-DNA水平检测不到，血清胆红素在正常范围内。FCH诊断12个月后，患者病情保持稳定，肝功能无进展。
我们的经验表明，拉米夫定治疗可改善FCH的不良自然病程。
