Liver transplantation for acute liver failure in 3 patients with lymphoma complicated with chronic hepatitis B after chemotherapy

Abstract

Objective To investigate the curative effect of liver transplantation (LT) for acute liver failure in patients with lymphoma complicated with chronic hepatitis B (CHB) after chemotherapy. Methods Clinical data of 3 patients with lymphoma complicated with CHB and acute liver failure after chemotherapy undergoing LT in the Third Affiliated Hospital of Sun Yat-sen University between March 2009 and July 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. The 3 patients were diagnosed as lymphoma complicated with CHB before operation. Hepatitis B virus (HBV) reactivated after multiple chemotherapies and caused acute liver failure. The intraoperative and postoperative immunosuppressive regimens and antiviral therapy of the patients were analyzed. The recurrence of lymphoma and HBV and survival prognosis after operation were observed. Results The 3 patients underwent emergency LT. The early postoperative immunosuppressive regimen was tacrolimus (FK506) + adrenocortical hormone (hormone). FK506 monotherapy was used when hormone was stopped in 3 months after LT. Anti-HBV treatment was strengthened after LT with the regimen of entecavir combined with hepatitis B immune globulin. The patients were followed up till the date of submission. One patient died of biliary stricture and septic shock 1 month after LT and the other 2 patients recovered well without recurrence of lymphoma and hepatitis B. Conclusions Patients with lymphoma complicated with CHB and acute liver failure after chemotherapy can achieve favorable curative effect by LT, on condition that hormone is withdrawn early after operation, antivirus treatment is strengthened and regular follow-up is given. Key words: Liver transplantation; Lymphoma; Hepatitis B virus; Liver failure, acute