A 64-year-old male patient with a history of hypertension and insulin-requesting type 2 diabetes mellitus.
In 2002, during tests for etiologic study of liver cirrhosis HBsAg (+) was researched with detection of viral DNA by PCR (HBV fast - PharmaGen).
A study was complemented with abdominal ultrasound which showed signs of chronic liver damage and portal hypertension, as well as upper endoscopy which showed small esophageal varices.
In 2003, the patient was hospitalized for hepatic encephalopathy. Tests highlighted the presence of HBsAg, HBeAg and HBV-DNA (+) by PCR. Treatment with adefovir was initiated 10 mg/day.
At the tenth month of therapy, he maintained HBeAg (+) and HBV-DNA (+), therefore, it was decided to add lamivudine 150 mg/day, achieving negative HBV-DNA results.
During this period she presents deterioration of liver function, with several episodes of encephalopathy that required hospitalization.
In August 2008, an increase in viral load up to 10600 IU/ml was observed.
Based on this, it is added to the antiviral scheme Truvada® (tenofovir 300 mg/emtricitabine 200 mg) achieving a decrease in viral load to 623 IU/ml.
At least three focal liver lesions compatible with hepatocellular carcinoma are observed in two imaging studies (CT and MRI).
1.
Ortotopic liver transplantation was performed on July 26th 2009, maintaining antiviral therapy during the anhepatic phase and in the immediate postoperative period HBIg (Grifols® for IM use) 3000 U in 300 cc of intravenous saline solution
Subsequent doses of HBIg were calculated according to anti-HBs antibody titers (EIA, IMx Abbott) Table.3.
Treatment with methyl prednisolone associated with tacrolimus and chemoprophylaxis with isoniazid was initiated during the first six months after transplantation.
Initial evolution was satisfactory, but later he presented sepsis due to Staphylococcus aureus and cytomegalovirus infection.
She was discharged with indication of monthly administration of HBIg (2,000 U IM) maintaining antiviral treatment with Truvada® one tablet/day.
To date, HBsAg is undetectable.
