• DOI:10.1002/lt.20492
• Corpus ID: 19746065

Management of the hepatitis B virus in the liver transplantation setting: A European and an American perspective

@article{Terrault2005ManagementOT,
  title={Management of the hepatitis B virus in the liver transplantation setting: A European and an American perspective},
  author={Norah A. Terrault and Bruno Roche and Didier Samuel},
  journal={Liver Transplantation},
  year={2005},
  volume={11}
}

• N. Terrault, B. Roche, D. Samuel
• Published 1 July 2005
• Medicine, Biology
• Liver Transplantation

Introduction A total of 5 to 10% of patients undergoing orthotopic liver transplantation (OLT) have hepatitis B virus (HBV)–associated chronic or fulminant liver disease. Long-term survival depends on the prevention of allograft reinfection or the slowing of disease progression in those who have recurrent disease. In the absence of prophylactic measures, the risk of HBV reinfection after OLT is approximately 80% and is related largely to the level of HBV replication at time of transplantation.1,2 Recurrent infection in the graft can lead to graft failure, retransplantation, or death and in the past was the most common cause of reduced patient and graft survival.1,2 Significant improvements in both patient and graft survival in HBV liver transplant recipients have been made during the past 15 years. The first major therapeutic advance was the use of long-term hepatitis B immune globulin (HBIG) to prevent reinfection.3,4 The second major advance came with the availability of highly effective and well-tolerated antiviral agents against HBV, such as lamivudine and adefovir dipivoxil, which improved the outcomes of both patients with decompensated cirrhosis awaiting transplantation5-7 as well as those transplant recipients who had recurrent HBV disease.7-9 Finally, with the use of HBIG in combination with antivirals (lamivudine and adefovir), the risk of reinfection has been reduced to 10% or less during the first 2 years following transplantation.10-14 As a result of these therapies, the outcomes of patients with acute and chronic HBV-related liver disease undergoing liver transplantation are now similar to or better than those of patients undergoing transplantation for non-HBV indications.15,16 While the therapeutic advances in the management of HBV in transplant recipients represents a major success story in transplantation in the past decade, there remain important challenges. Long-term prophylaxis with HBIG is expensive and inconvenient and has been associated with the development of surface antigen mutations. Similarly, emergence of lamivudine and adefovir resistance occurs with prolonged therapy in patients awaiting OLT and in those with recurrent disease posttransplantation. Thus, new, more cost-effective strategies to prevent reinfection and new antiviral agents with activity against resistant HBV mutants are needed. Additionally, strategies that would eliminate the need for long-term or indefinite therapy, such as therapeutic vaccination and other immune therapies, would further optimize outcomes in liver transplant recipients with HBV.