Case Report
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World J Hepatol. Dec 27, 2010; 2(12): 447-450
Published online Dec 27, 2010. doi: 10.4254/wjh.v2.i12.447
Simple nucleos(t)ides as HBV prophylaxis regime of post-liver transplantation: Six-year followed up
Kang-Xian Luo, Fu-Yuan Zhou, Ding-Li Liu, Xiao-Rong Feng
Kang-Xian Luo, Fu-Yuan Zhou, Ding-Li Liu, Xiao-Rong Feng, Hepatology Center, Nanfang Hospital, Southern Medical Univercity, Guangzhou 510515, Guangdong Province, China
Author contributions: Luo KX was the consultant and writer; and Zhou FY, Liu DL and Feng XR participated in patient care.
Correspondence to: Kang-Xian Luo, Professor, Hepatology Center, Nanfang Hospital, Southern Medical Univercity, Guangzhou 510515, Guangdong Province, China. luokangxian@yahoo.com.cn
Telephone: +86-13672457690 Fax: +86-20-87636914
Received: March 11, 2010
Revised: November 9, 2010
Accepted: November 16, 2010
Published online: December 27, 2010
Abstract

A combination of nucleos(t)ides and hepatitis B immunoglobulin (HBIg) has been found to be effective for the prevention of hepatitis B viral (HBV) reinfection after liver transplantation (LT), but its administration is costly, and not always available. We report the case of a male, 33-year-old cirrhotic patient who has tested positive for serum HBsAg, and HBeAg, with 9.04 × 107 copies/mL of HBV DNA. He suffered from acute liver failure and was near death before undergoing emergency LT. No HBIg was available at the time, so only lamivudine was used. He routinely received immunosuppression medication. Serum HBV DNA and HBsAg still showed positive post-LT, and the graft re-infected. Hepatitis B flared three months later. Adefovir dipivoxil was added to the treatment, but in the 24th mo of treatment, the patient developed lamivudine resistance and a worsening of the hepatitis occurred shortly thereafter. The treatment combination was then changed to a double dosage of entecavir and the disease was gradually resolved. After 60-mo of post-LT nucleos(t)ide analogue therapy, anti-HBs seroconverted, and the antiviral was stopped. By the end of a 12-mo follow-up, the patient had achieved sustained recovery. In conclusion, the case seems to point to evidence that more potent and less resistant analogues like entecavir might fully replace HBIg as an HBV prophylaxis and treatment regimen.

Keywords: Chronic hepatitis B; Hepatitis B immunoglobulin; Liver transplantation; Nucleos(t)ides