Transplante hepático em paciente com coinfecção pelos vírus B, C e D associada a carcinoma hepatocelular
uma estratégia de tratamento para uma condição rara. Relato de caso
Palavras-chave:
Hepatite B, Hepatite C, Hepatite D, Carcinoma hepatocelular, Transplante de fígadoResumo
CONTEXTO: O transplante ortotópico de fígado (TOF) é o tratamento de escolha em pacientes com do-ença hepática terminal. A cirrose por hepatite C é a principal indicação de transplante hepático no mundo. No entanto, pacientes transplantados por hepatopatias virais frequentemente apresentam coinfecções, como hepatite B associada a hepatite D. Atualmente, existem diferentes estratégias de manejo em pa-cientes pré e pós-transplantados conforme diferentes protocolos de conduta de serviços especializados em transplante. RELATO DE CASO: Apresentamos o raro caso de um homem de 58 anos diagnosticado com as he-patites crônicas B, C e D. O paciente evoluiu com cirrose e carcinoma hepatocelular. O tratamento consistiu de terapia antiviral para os três vírus e de transplante ortotópico de fígado. O desfecho do paciente foi satisfatório. CONCLUSÃO: O transplante ortotópico de fígado, associado à terapia antiviral com entecavir antes e após o procedimento, foi eficaz na depuração sustentada dos vírus B e D. A recidiva do vírus C após o transplan-te respondeu com sucesso ao tratamento padrão com alfapeginterferon 2A e ribavirina.
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