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Nasir M, Wu GY. Prevention of HBV Recurrence after Liver Transplant: A Review. J Clin Transl Hepatol. 2020;8(2):150-160doi: 10.14218/JCTH.2020.00003.
Nasir, M., & Wu, G. Y. (2020). Prevention of HBV Recurrence after Liver Transplant: A Review. Journal of clinical and translational hepatology, 8(2), 150-160. https://doi.org/10.14218/JCTH.2020.00003
Nasir, Myra, and Wu, George Y. "Prevention of HBV Recurrence after Liver Transplant: A Review." Journal of clinical and translational hepatology vol. 8,2 (2020): 150-160. doi: https://doi.org/10.14218/JCTH.2020.00003
Nasir M, Wu GY. Prevention of HBV Recurrence after Liver Transplant: A Review. J Clin Transl Hepatol. 2020 Jun 28;8(2):150-160. doi: 10.14218/JCTH.2020.00003. Epub 2020 May 25. PMID: 32832395; PMCID: PMC7438351.
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J Clin Transl Hepatol. 2020 Jun 28;8(2):150-160. doi: 10.14218/JCTH.2020.00003. Epub 2020 May 25.

Prevention of HBV Recurrence after Liver Transplant: A Review.

Journal of clinical and translational hepatology

Myra Nasir, George Y Wu

Affiliations

  1. Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA.

PMID: 32832395 PMCID: PMC7438351 DOI: 10.14218/JCTH.2020.00003

Abstract

Globally, hepatitis B virus (HBV) infection is recognized as a major risk factor for the development of hepatocellular carcinoma, and HBV-induced liver failure is one of the leading indications for liver transplantation. Until about two decades ago, liver transplantation in patients with chronic HBV infection was a relative contraindication, due to high risk of viral replication with the use of immunosuppressants which could result in graft infection. In the 1990s, hepatitis B immunoglobulin (HBIg) use significantly reduced the risk of graft infection, improving outcomes of liver transplant in patients with chronic HBV infection. However, very high costs, especially with the need for long-term use, became a major concern. With the advent of nucleos(t)ide analogs (NAs), there was less need for high-dose, long-term HBIg use to prevent HBV recurrence. Lamivudine was initially used but resistance soon became a major issue. This was followed by more potent NAs, such as entecavir and tenofovir, emerging as the more preferred agents. Additionally, the use of these antiviral agents (HBIg and/or NAs) have made it possible to use the grafts from donors with positivity for hepatitis B core antibody, allowing for expansion of the donor pool. Nevertheless, there is no consensus on management protocols, which vary significantly amongst centers. In this review, we appraise studies on management strategies used and the role of active vaccination in the prevention of HBV recurrence in post-liver transplant patients.

© 2020 Authors.

Keywords: Hepatitis B; Liver transplant; Recurrence; Vaccination

Conflict of interest statement

The authors have no conflict of interests related to this publication.

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