Treatment of hepatitis B virus reactivation in a cadaveric renal transplant recipient with entecavir.

INTRODUCTION Risk of reactivation of Hepatitis B virus (HBV) infection and other liver related complications continues to be a major cause of concern in HBV carriers undergoing cadaveric renal transplantation. Antiviral medications have been recommended post renal transplantation in patients who are chronic HBV carriers. CASE REPORT Here we present the case of a 15-year-old girl known to have kidney failure and chronic active HBV infection indicated by positivity of both HBsAg and HBeAg. She was treated with interferon alpha for six months resulting in clearance of HBeAg and reduction of HBV-DNA titer to 32.15 copies/ml. She underwent successful cadaveric renal transplantation and was maintained on cyclosporine, azathioprine and prednisolone. Two years post transplant, the patient developed elevated liver enzymes, positive HBeAg and high HBV-DNA titers. She was treated with lamivudin resulting in normalization of liver function tests. Lamivudine was discontinued after nine months due to poor compliance resulting from psychological problems. Three years post transplant, the patient was started on Entecavir 0.5 mg oral, daily. At follow up clinic visits till present time, the patient is tolerating Entecavir treatment with no reported side effects. Liver enzymes remained stable, but the effect on viral load and viral markers was unremarkable. CONCLUSION The role of various antiviral agents in treating HBV infection among kidney transplant recipients requires further evaluation.