[Ambulatory management of hepatitis B before and after liver transplantation]

A 48-year-old patient from Pakistan was referred with scleral icterus, ascites and lower limb edema.

The patient was suffering from post-hepatitis liver cirrhosis, CHILD stage B, with underlying chronic hepatitis B and C coinfection.

One year after diagnosis, orthotopic liver transplantation (OLT) was performed. To avoid recurrence of the hepatitis B in the transplant, the patient was given a treatment with lamivudine preoperatively. A prophylaxis with a combination of lamivudine and hepatitis B immunoglobulin peri- and postoperatively has been given for more than 5 years.

The use of lamivudine and hepatitis B immunoglobulin improves transplant survival in patients who have undergone OLT on the basis of post-hepatitis liver cirrhosis secondary to chronic hepatitis B. Costs are reduced by administering the hepatitis B immunoglobulin intramuscularly and by managing the preoperative and aftercare of the patient on an outpatient basis.