A case of acute rejection shortly after initiation of lamivudine therapy in a simultaneous pancreas and kidney recipient with viral hepatitis type B

: We describe a patient with hepatitis B antigenemia, who received a simultaneous pancreas and kidney transplant, developed reactivation of hepatitis B virus infection with aminotransferase elevation, and unexpectedly suffered an acute rejection episode within a few weeks after initiation of lamivud...

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Bibliographic Details
Published in:Transplant infectious disease 2009-12, Vol.11 (6), p.553-556
Main Authors: Chudek, J., Kolonko, A., Ficek, J., Karkoszka, H., Baka‐Ćwierz, B., Więcek, A.
Format: Article
Language:English
Subjects:
acute rejection
Adult
Antiviral Agents - administration & dosage
Antiviral Agents - adverse effects
Antiviral Agents - therapeutic use
dose adjusting
Graft Rejection - etiology
Hepatitis B - drug therapy
Hepatitis B - virology
Hepatitis B virus - drug effects
Hepatitis B virus - immunology
Hepatitis B virus - isolation & purification
Humans
immunosuppression
Kidney Transplantation - adverse effects
lamivudine
Lamivudine - administration & dosage
Lamivudine - adverse effects
Lamivudine - therapeutic use
Male
Pancreas Transplantation - adverse effects
simultaneous pancreas and kidney transplant
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Summary:: We describe a patient with hepatitis B antigenemia, who received a simultaneous pancreas and kidney transplant, developed reactivation of hepatitis B virus infection with aminotransferase elevation, and unexpectedly suffered an acute rejection episode within a few weeks after initiation of lamivudine therapy. At the time of rejection diagnosis, the cyclosporin A (CyA) trough level was 2 times lower than before the start of lamivudine therapy. Only an improvement in liver CyA metabolism in the course of lamivudine therapy can explain such an essential decline. Thus, it is important to emphasize how crucial it is to frequently monitor the CyA level in the early period of lamivudine therapy in transplanted patients with hepatitis to ensure adequate immunosuppression and to avoid acute rejection episodes.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2009.00442.x