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| Abstract |
Hepatitis B virus (HBV) recurrence after liver transplantation for HBV-associated liver diseases results in decreased patient and graft survival. Herein we have reported two cases of HBV recurrence fo...llowing relapse of hepatocellular carcinoma (HCC) after living donor liver transplantation (LDLT). Both cases had LDLT for end-stage liver disease secondary to HBV infection with nodules of HCC exceeding the Milan criteria. HBV prophylaxis using hepatitis B immunoglobulin with nucleos (t) ide analogues were given and HBV DNA levels were consistently undetectable after LDLT. HCC recurred at 5 months and 13 months posttransplant respectively, and chemotherapy and radiation therapy were performed. HBV recurrence occurred during the treatment of HCC. HBV DNA levels increased despite the treatment with anti-HBV agents after HBV recurrence. In hepatitis B surface antigen positive recipients, HBV prophylaxis should be intensified during the treatment of recurrent HCC.
肝移植後のB型肝炎の再発は移植成績を低下させる. 生体肝移植後に肝細胞癌再発を認め,その後B型肝炎の再発を認めた2例を経験したので報告する. いずれもミラノ基準を超えた肝細胞癌とB型肝炎による非代償性肝硬変に対する生体肝移植後であった. B型肝炎に対する免疫グロブリンと核酸アナログが投与され, B型肝炎の再発予防が行われ, いずれも血中のB型肝炎は検出できないレベルでコントロールされていた. 肝細胞癌はそれぞれ移植後5ヶ月, 13ヶ月後に再発し, 放射線療法と化学療法が施行された. 抗ウイルス療法にもかかわらず, 再発肝細胞癌に対する治療中にB型肝炎のDNAレベルは上昇した. HBs 抗原陽性のレシピエントにおいては再発肝細胞癌の治療の間, B型肝炎再発予防を十分注意しながら行う必要がある.show more
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