Mycophenolate mofetil/steroids/tacrolimus
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Detectable levels of Hepatitis-B virus DNA: case report A man in his late 40s exhibited detectable levels of Hepatitis-B virus (HBV) DNA during immunosuppressive therapy with mycphenolate mofetil, tacrolimus and unspecified steroids. The man was admitted with a diagnosis of hepatitis-D 1 infection and chronic hepatitis-B genotype-d at the age of 45 years. He had history of hepatitis-B since 5 years, along with Child’s B liver cirrhosis, ascites, deranged liver function and general fatigue. His ascites did not respond to unspecified antidiuretics. Serum HBV markers were positive for HBsAg, anti-HBs, anti-HBc IgG, anti-HBe and negative for HBeAg. His serum HBV DNA levels were positive but below measurable range. He was not treated with any antiviral agent. He underwent orthotopic liver transplantation in January 2006. The liver was donated by a 48-year-old deceased donor with positive HBsAg and anti-HBc IgG markers. During the anhepatic phase, the recipient received infusion of 10 000IU of hepatitis-B immunoglobulin followed by 2 000IU daily for 2 weeks and then continued for six months. On the first day of transplantation, he started receiving prophylactic therapy with lamivudine 100 mg/day and adefovir dipivoxil 10 mg/day started on the first day after transplant. His immunosuppressant therapy included mycophenolate mofetil, tacrolimus and unspecified steroids, but steroids were tapered in the subsequent months [dosages and routes not stated]. Postoperatively, he recovered quickly and was discharged on day 17 after transplant with normal liver function. On day 17, his HBV DNA was very low levels at
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