B型肝炎ウイルス既感染を伴う血友病関連C型肝硬変患者に脳死肝移植を施行した1例

抄録

We report a case of deceased donor liver transplantation (DDLT) to an HBc-antibody-positive patient with hepatitis C virus (HCV) and liver cirrhosis due to hemophilia. A 45-year-old man had been suffering from hemophilia from the age of two and was diagnosed with the hepatitis B virus (HBV) and HCV infection owing to frequent blood derivative administration. He was finally evaluated for decompensated liver cirrhosis, with medical urgency and MELD scores of 8 and 28 points, respectively. Therefore, he was registered on the DDLT waiting list. Since he agreed with the donor call on the 22nd day after registration, we performed a regular DDLT employing a venous bolus infusion of hepatitis B immune globulin for prophylaxis. Factor VIII activity rose to 20-30%, and the APTT was shortened to 40-50 sec after the DDLT. The HBs-antibody titer exceeded 100 mIU/mL, and the HBV-DNA was thoroughly negative without the administration of entecavir. He was discharged on the 94th postoperative day and is receiving anti-HCV treatment without hepatitis B virus reactivation. Unlike the usual coinfection of hemophilia is human immunodeficiency virus and HCV, we experienced an extremely rare case of coinfection of HBV and HCV. HBc-antibody-positive recipients are not well discussed in the literature, in contrast to HBc-antibody-positive donors, because it is naturally thought that HBV cannot live and replicate in extrahepatic cells. However, there is no obvious evidence regarding the impossibility of extrahepatic replication and reactivation in HBc-antibody-positive recipients at this time; therefore, a careful follow-up of HBV reactivation is needed for HBc-antibody-positive recipients.