Ganciclovir treatment of active hepatitis B virus infection in a heart transplant patient

Hepatitis B virus (HBV) infection in patients who undergo organ transplantation is a serious illness, associated with progressive and often fatal liver disease. Attempts at eradication of infection with antiviral agents, such as interferon and adenine arabinoside, have produced disappointing results. Similarly, prevention of HBV reinfection with the use of passive immunization with hepatitis B immunoglobulin or a combination of active and passive immunization have not been uniformly successful. We report the successful use of ganciclovir, a synthetic analogue of 2-deoxyguanosine, in a heart transplant patient with active HBV infection. The patient developed decompensated liver disease with ascites, edema, and marked derangement of liver tests despite drastic reduction in immunosuppressive therapy. Ganciclovir therapy was administered intravenously, and the patient showed remarkable improvement with clinical recovery and normalization of the liver tests. Moreover, the serum HBV DNA and hepatitis B e antigen became undetectable. Ganciclovir was a safe and effective treatment of HBV infection in this transplant patient.