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Locasciulli A, Montante B, Morelli E, et al. Hepatitis B and C in hematopoietic stem cell transplant. Mediterr J Hematol Infect Dis. 2009;1(3):e2009016doi: 10.4084/MJHID.2009.016.
Locasciulli, A., Montante, B., Morelli, E., Gulino, V., Proia, A., & Pinazzi, M. B. (2009). Hepatitis B and C in hematopoietic stem cell transplant. Mediterranean journal of hematology and infectious diseases, 1(3), e2009016. https://doi.org/10.4084/MJHID.2009.016
Locasciulli, Anna, et al. "Hepatitis B and C in hematopoietic stem cell transplant." Mediterranean journal of hematology and infectious diseases vol. 1,3 (2009): e2009016. doi: https://doi.org/10.4084/MJHID.2009.016
Locasciulli A, Montante B, Morelli E, Gulino V, Proia A, Pinazzi MB. Hepatitis B and C in hematopoietic stem cell transplant. Mediterr J Hematol Infect Dis. 2009 Dec 03;1(3):e2009016. doi: 10.4084/MJHID.2009.016. PMID: 21415955; PMCID: PMC3033124.
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Mediterr J Hematol Infect Dis. 2009 Dec 03;1(3):e2009016. doi: 10.4084/MJHID.2009.016.

Hepatitis B and C in hematopoietic stem cell transplant.

Mediterranean journal of hematology and infectious diseases

Anna Locasciulli, Barbara Montante, Emanuela Morelli, Virginia Gulino, Anna Proia, Maria Beatrice Pinazzi

Affiliations

  1. Pediatric Hematology Hematology Departments, San Camillo Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.

PMID: 21415955 PMCID: PMC3033124 DOI: 10.4084/MJHID.2009.016

Abstract

Although the risk of acquisition of hepatitis B or hepatitis C virus through blood products has considerably reduced since the last decade, some infected patients are candidates to stem cell transplantation. Others may have no alternative than an infected donor. In all these cases, recipients of transplant are prone to short and long term liver complications. The evolution of liver tests under chemotherapy before transplant may give useful information to anticipate on the risk of hepatitis reactivation after transplant, both for HBv and HCv. More than sixty percent of the patients who are HBsAg-positive before transplant reactivate after transplant, and 3% develop acute severe liver failure. Because both viral replication and immune reconstitution are the key factors for reactivation, it is crucial to closely follow liver function tests and viral load during the first months of transplant, and to pay a special attention in slowly tapering the immunosuppression in these patients. Lamivudine reduces HBv viremia, but favors the emergence of HBv polymerase gene mutants and should be individually discussed. Both in case of HBv or HCv hepatitis reactivation with ALT ≥ 10N concomitantly to an increase in viral load at time of immune reconstitution, steroids should be given. In case there is no alternative than a HBv or HCv positive geno-identical donor, the risk of viral hepatitis, including acute liver failure and late complications, should be balanced with the benefit of transplant in a given situation.

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