title: Liver transplantation in a patient with hepatitis B, C and D coinfection associated with hepatocellular carcinoma: a management strategy for a rare condition. Case report.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage liver disease. Cirrhosis due to hepatitis C infection is the leading indication for liver transplantation worldwide. However, patients who are given transplants because of viral liver diseases often present clinical coinfections, including hepatitis B together with hepatitis D. Currently, different strategies exist for patient management before and after liver transplantation, and these are based on different protocols developed by the specialized transplantation centers.
  
  
  METHODS
  We present a rare case of a 58-year-old man with chronic hepatitis B, C and D coinfection. The patient developed cirrhosis and hepatocellular carcinoma. His treatment comprised antiviral therapy for the three viruses and OLT. The patient's outcome was satisfactory.
  
  
  CONCLUSIONS
  OLT, in association with antiviral therapy using entecavir, which was administered before and after transplantation, was effective for sustained clearance of the hepatitis B and D viruses. A recurrence of hepatitis C infection after transplantation responded successfully to standard treatment comprising peginterferon alfa-2A and ribavirin.
authors.affiliation: Health Sciences Center, Universidade Federal do Acre, Rio Branco, Acre, Brazil.
authors.forename: Lucas Carvalho
authors.initials: LC
authors.lastname: Dantas
authors.affiliation: Hospital Beneficência Portuguesa, São Paulo, São Paulo, Brazil.
authors.forename: Tércio
authors.initials: T
authors.lastname: Genzini
authors.affiliation: Hospital Beneficência Portuguesa, São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Perosa de
authors.initials: MP
authors.lastname: Miranda
authors.affiliation: Hospital Beneficência Portuguesa, São Paulo, São Paulo, Brazil.
authors.forename: Regina Gomes dos
authors.initials: RG
authors.lastname: Santos
authors.affiliation: Hospital das Clínicas do Acre, Rio Branco, Acre, Brazil.
authors.forename: Nilton Ghiotti de
authors.initials: NG
authors.lastname: Siqueira
authors.affiliation: Hospital das Clínicas do Acre, Rio Branco, Acre, Brazil.
authors.forename: Judith
authors.initials: J
authors.lastname: Weirich
authors.affiliation: Hospital das Clínicas do Acre, Rio Branco, Acre, Brazil.
authors.forename: Cirley Maria de Oliveira
authors.initials: CM
authors.lastname: Lobato
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D060085:Coinfection / Q000188:drug therapy / Q000601:surgery; D006509:Hepatitis B / Q000188:drug therapy / Q000601:surgery; D006526:Hepatitis C / Q000188:drug therapy / Q000601:surgery; D003699:Hepatitis D / Q000188:drug therapy / Q000601:surgery; D006525:Hepatitis, Viral, Human / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a