A 58-year-old male patient, born in Uruguay, residing in Santiago, with a history of pulmonary tuberculosis in 1976, was complicated by a hepatitis secondary to isoniazid.
In August 2006, it debuts with acute hepatitis, whose study demonstrated acute HBV infection (HBsAg, Anti HBcAg total, Anti HBcIgM genotype and HBeAg positive) with virological failure genotype 6
During the following year, she was hospitalized several times for recurrent hepatic encephalopathy and ascites.
In his last admission, he achieved a MELD score of 28, so he was considered an emergency liver transplant candidate.
1.
The transplant was performed on March 24, 2008, evolving in the immediate postoperative period with hypovolemic shock and renal failure due to acute tubular necrosis.
He recovered renal function rapidly and started immunosuppressant treatment with tacrolimus (T-immun®).
During the anhepatic phase and in the immediate postoperative period, 5,000 U of IHBg (Grifols® for IM use) was administered in 300 cc of intravenous saline, maintaining antiviral treatment with entecavir.
AntiHBs and HBsAg titers were measured at baseline and daily after each administration of HBIg.
HBsAg negativization was observed on the eighth day after transplantation.
Table 2 shows the anti-HBs titers and the administered dose of HBIg.
The patient recovered satisfactorily and was discharged on the 11th day after transplantation.
Subsequently, he received HBIg weekly during the first month, and then monthly (2,000 U IM) maintaining entecavir 0.5 mg/day.
Antituberculosis chemoprophylaxis with isoniazid was used during the first six months after transplantation without adverse effects.
To date, HBsAg is undetectable.
