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Maiwall R, Kumar M. Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation. J Clin Transl Hepatol. 2016;4(1):54-65doi: 10.14218/JCTH.2015.00041.
Maiwall, R., & Kumar, M. (2016). Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation. Journal of clinical and translational hepatology, 4(1), 54-65. https://doi.org/10.14218/JCTH.2015.00041
Maiwall, Rakhi, and Kumar, Manoj. "Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation." Journal of clinical and translational hepatology vol. 4,1 (2016): 54-65. doi: https://doi.org/10.14218/JCTH.2015.00041
Maiwall R, Kumar M. Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation. J Clin Transl Hepatol. 2016 Mar 28;4(1):54-65. doi: 10.14218/JCTH.2015.00041. Epub 2016 Mar 15. PMID: 27047773; PMCID: PMC4807144.
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J Clin Transl Hepatol. 2016 Mar 28;4(1):54-65. doi: 10.14218/JCTH.2015.00041. Epub 2016 Mar 15.

Prevention and Treatment of Recurrent Hepatitis B after Liver Transplantation.

Journal of clinical and translational hepatology

Rakhi Maiwall, Manoj Kumar

Affiliations

  1. Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India.

PMID: 27047773 PMCID: PMC4807144 DOI: 10.14218/JCTH.2015.00041

Abstract

Chronic hepatitis B is a global health problem that leads to development of various complications, such as cirrhosis, liver cancer, and liver failure requiring liver transplantation. The recurrence of hepatitis B virus (HBV) post-liver transplantation is a major cause of allograft dysfunction, cirrhosis of the allograft, and graft failure. Patients with high viral load at the time of transplantation, hepatitis B e antigen (HBeAg) positivity, or those with a history of anti-viral drug resistance are considered as high-risk for recurrent HBV post-liver transplantation, while patients with low viral load, including HBeAg negative status, acute liver failure, and hepatitis D virus (HDV) co-infection are considered to be at low-risk for recurrent HBV post-liver transplantation. Antivirals for patients awaiting liver transplantation(LT) cause suppression of HBV replication and reduce the risk of recurrent HBV infection of the allograft and, therefore, all HBV patients with decompensated cirrhosis should be treated with potent antivirals with high genetic barrier to resistance (entecavir or tenofovir) prior to liver transplantation. Prevention of post-liver transplantation recurrence should be done using a combination of hepatitis B immunoglobulin (HBIG) and antivirals in patients at high risk of recurrence. Low dose HBIG, HBIG-free protocols, and monoprophylaxis with high potency antivirals can still be considered in patients at low risk of recurrence. Even, marginal grafts from anti-HBc positive donors can be safely used in hepatitis B surface antigen (HBsAg) negative, preferably in anti-hepatitis B core (HBc)/anti-hepatitis B surface (HBs) positive recipients. In this article, we aim to review the mechanisms and risk factors of HBV recurrence post-LT in addition to the various treatment strategies proposed for the prevention of recurrent HBV infection.

Keywords: Hepatitis B; Liver transplant; Recurrent

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