• Lucas Carvalho Dantas, Tércio Genzini, MirandaMarcelo Perosa deMPHospital Beneficência Portuguesa, São Paulo, São Paulo, Brazil., Regina Gomes dos Santos, Nilton Ghiotti de Siqueira, Judith Weirich, and Cirley Maria de Oliveira Lobato.
• Health Sciences Center, Universidade Federal do Acre, Rio Branco, Acre, Brazil.
• Sao Paulo Med J. 2015 Nov 1; 133 (6): 525530525-30.

ContextOrthotopic 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.Case ReportWe 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.ConclusionOLT, 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.

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