Skip to main content
SpringerLink
Log in

Management of recurrent viral hepatitis B and C after liver transplantation

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Liver transplant teams are often faced with the challenges of managing viral recurrence after liver transplantation. Hepatitis C virus (HCV) remains the most challenging viral disease in the transplant community. Strategies to prevent and delay viral recurrence have slowly developed over the past 5 years. Hepatitis B virus (HBV), previously a contraindication for liver transplantation due to recurrence and cholestasis with allograft failure, is now one of the more favorable indications for liver transplantation as a result of current therapeutic options. This review investigates the up-to-date information on treatment outcomes for HCV and HBV in the period following liver transplant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Charlton M, Seaberg E, Wiesner R, et al.: Predictors of patient and graft survival following liver transplantation for hepatitis C. Hepatology 1998, 28:823–830.

    Article  PubMed  CAS  Google Scholar 

  2. Fried MW, Khudyakov YE, Smallwood GA, et al.: Hepatitis G virus co-infection in liver transplantation recipients with chronic hepatitis C and nonviral chronic liver disease. Hepatology 1997, 25:1271–1275.

    Article  PubMed  CAS  Google Scholar 

  3. Neumann UP, Berg T, Bahra M, et al.: Long-term outcome of liver transplants for chronic hepatitis C: a 10-year follow-up. Transplantation 2004, 77:226–231.

    Article  PubMed  Google Scholar 

  4. Pelletier SJ, Iezzoni JC, Crabtree TD, et al.: Prediction of liver allograft fibrosis after transplantation for hepatitis C virus: persistent elevation of serum transaminase levels versus necroinflammatory activity. Liver Transpl 2000, 6:44–53.

    PubMed  CAS  Google Scholar 

  5. Prieto M, Berenguer M, Rayon JM, et al.: High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes. Hepatology 1999, 29:250–256.

    Article  PubMed  CAS  Google Scholar 

  6. Wright TL, Donegan E, Hsu HH, et al.: Recurrent and acquired hepatitis C viral infection in liver transplant recipients. Gastroenterology 1992, 103:317–322.

    PubMed  CAS  Google Scholar 

  7. Fattovich G, Giustina G, Degos F: Morbidity and mortality in compensated cirrhosis type C. Gastroenterology 1997, 112:463–472.

    Article  PubMed  CAS  Google Scholar 

  8. Neff GW, Montalbano M, O'Brien CB, et al.: Treatment of established recurrent hepatitis C in liver-transplant recipients with pegylated interferon-alfa-2b and ribavirin therapy. Transplantation 2004, 78:1303–1307.

    Article  PubMed  CAS  Google Scholar 

  9. Burroughs AK: Posttransplantation prevention and treatment of recurrent hepatitis C. Liver Transpl 2000, 6:S35-S40.

    Article  PubMed  CAS  Google Scholar 

  10. CharltonM: Natural history of hepatitis C and outcomes following liver transplantation. Clin Liver Dis 2003, 7:585–602. A very thorough report of the outcomes in liver transplant recipients suffering from HCV.

    Article  PubMed  Google Scholar 

  11. Neff GW, O'Brien C, Safdar K, et al.: Preemptive therapy with combination pegylated interferon and ribavirin in liver transplant recipients with hepatitis C virus. Poster presented at DDW New Orleans; 2004.

  12. Ghalib RH, Levine CD, Stribling R, et al.: Treatment of recurrent heaptitis C after liver transplantation with pegylated interferon lafa-2b plus ribavirin. Gastroenterology 2003, 124:A-694.

    Article  Google Scholar 

  13. Smallwood GA, Davis L, Connor K, et al.: Nonresponders of interferon/ribavirin treatment for recurrent hepatitis C following liver transplantation. Transplant Proc 2003, 35:1476–1477.

    Article  PubMed  CAS  Google Scholar 

  14. Ross AS, Bhan AK, Pascual M, et al.: Pegylated interferon alpha-2b plus ribavirin in the treatment of post-liver transplant recurrent hepatitis C. Clin Transplant 2004, 18:166–173.

    Article  PubMed  Google Scholar 

  15. Crippin JS, McCashland T, Terrault N, Sheiner P, Charlton MR: A pilot study of the tolerability and efficacy of antiviral therapy in hepatitis C virus-infected patients awaiting liver transplantation. Liver Transpl 2002, 8:350–355.

    Article  PubMed  Google Scholar 

  16. Everson G, Trotter JF, Forman L, et al.: Treatment of advanced hepatitis C with a low accelerating dosage regimen of antiviral therapy. Hepatology 2005, 42:255–262.

    Article  PubMed  CAS  Google Scholar 

  17. Singh N, Gayowski T, Ndimbie OK, et al.: Recurrent hepatitis C virus hepatitis in liver transplant recipients receiving tacrolimus: association with rejection and increased immunosuppression after transplantation. Surgery 1996, 119:452–456.

    Article  PubMed  CAS  Google Scholar 

  18. Fong TL, Valinluck B, Govindarajan S, et al.: Short term prednisone therapy affects aminotransferase activity and hepatitis C virus RNA levels in chronic hepatitis C. Gastroenterolgy 1994, 107:196–199.

    CAS  Google Scholar 

  19. Teixeira R, Pastacaldi S, Papatheodoridis GV, Burroughs AK: Recurrent hepatitis C after liver transplantation. J Med Virol 2000, 61:443–454.

    Article  PubMed  CAS  Google Scholar 

  20. Berenguer M, Ferrell L, Watson J, et al.: HCV-related fibrosis progression following liver transplantation: increase in recent years. J Hepatol 2000, 32:673–684.

    Article  PubMed  CAS  Google Scholar 

  21. Fong TL, Arnaout WS, Herha GI: Long term outcome of transplantation for hepatitis C. Hepatology 1999, 30:245A.

    Google Scholar 

  22. Ghobrial RM: Retransplantation for recurrent hepatitis C. Liver Transpl 2002, 8:S38–43.

    Article  PubMed  Google Scholar 

  23. Neff GW, delaGarza J, Shire N, et al.: The long-term effects of immune suppression on liver transplant recipients with recurrent hepatitis C viral infection. Transplant Proc 2004, 36:3065–3067.

    Article  PubMed  CAS  Google Scholar 

  24. BerenguerM: What determines the natural history of recurrent hepatitis C after liver transplantation? J Hepatol 2005, 42:448–456. This article discusses the importance of maintaining stable immune suppression through the posttransplant phase. Abrupt changes or inappropriate lowering or elevation of immune suppression can add to allograft dysfunction.

    Article  PubMed  Google Scholar 

  25. Neff GW, Ruiz P, Madariaga JR, et al.: Sirolimus-associated hepatotoxicity in liver transplantation. Ann Pharmacother 2004, 38:1593–1596.

    Article  PubMed  CAS  Google Scholar 

  26. Rimola A, Londono MC, Guevara G, et al.: Beneficial effect of angiotensin-blocking agents on graft fibrosis in hepatitis C recurrence after liver transplantation. Transplantation 2004, 78:686–691.

    Article  PubMed  CAS  Google Scholar 

  27. Rincon D, Nogales O, Salcedo M, et al.: The influence of ACE-inhibitors (ACEI) in the evolution of fibrosis after liver transplantation in HCV patients. J Hepatol 2005, 42:s58.

    Google Scholar 

  28. Wiesner RH, Krom RA: Liver transplantation for hepatitis B: the con aspect. Liver Transplant Surg 1995, 1:265–270.

    Article  CAS  Google Scholar 

  29. Jansen PL, Haagsma EB, Klompmaker IJ, et al.: Hepatitis B-associated liver cirrhosis as an indication for liver transplantation. Scand J Gastroenterol 1995, 212(Suppl):19–22.

    CAS  Google Scholar 

  30. Fang JW, Tung FY, Davis GL, et al.: Fibrosing cholestatic hepatitis in a transplant recipient with hepatitis B virus precore mutant. Gastroenterology 1993, 105:901–904.

    PubMed  CAS  Google Scholar 

  31. Van TheilDH, Schade RR, Gavaler JS, et al.: Medical aspects of liver transplantation. Hepatology 1984, 4:79S-83S.

    Article  Google Scholar 

  32. Samuel D, Alexander G: Liver transplantation for hepatitis B virus infection. Liver Transplant Surg 1995, 1:270–274.

    Article  CAS  Google Scholar 

  33. Pramoolsinsup C: Management of viral hepatitis B. J Gastroenterol Hepatol 2002, 17(Suppl):S125-S145.

    Article  PubMed  Google Scholar 

  34. Marzano A, Gaia S, Ghisetti V, et al.: Viral load at the time of liver transplantation and risk of hepatitis B virus recurrence. Liver Transpl 2005, 11:402–409.

    Article  PubMed  Google Scholar 

  35. NeffGW, O'Brien CB, Nery J, et al.: Outcomes in liver transplant recipients with hepatitis B virus: resistance and recurrence patterns from a large transplant center over the last decade. Liver Transpl 2004, 10:1372–1378. This review from a large transplant center over a 10-year period discusses the importance of HBV DNA-negative status at the time of transplant.

    Article  PubMed  Google Scholar 

  36. Samuel D: Management of hepatitis B in liver transplantation patients. Semin Liver Dis 2004, 24(Suppl 1):55–62.

    Article  PubMed  CAS  Google Scholar 

  37. Alonso I, Herreros de Tejada A, Moreno JM, et al.: Effectiveness of low-dose intramuscular anti-VHB immune globulin in the prophylaxis of viral B hepatitis reinfection after liver transplantation: preliminary report. Transplant Proc 2003, 35:1850–1851.

    Article  PubMed  CAS  Google Scholar 

  38. Samuel D, Muller R, Alexander G, et al.: Liver transplantation in European patients with the hepatitis B surface antigen [comment]. N Engl J Med 1993, 329:1842–1847.

    Article  PubMed  CAS  Google Scholar 

  39. Samuel D, Bismuth H, Benhamou JP: Liver transplantation in cirrhosis due to hepatitis D virus infection. J Hepatol 1993, 17(Suppl 3):S154-S156.

    Article  PubMed  Google Scholar 

  40. Sawyer RG, McGory RW, Gaffey MJ, et al.: Improved clinical outcomes with liver transplantation for hepatitis B-induced chronic liver failure using passive immunization. Ann Surg 1998, 227:841–850.

    Article  PubMed  CAS  Google Scholar 

  41. McGory RW, Ishitani MB, Oliveira WM, et al.: Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization. Transplantation 1996, 61:1358–1364.

    Article  PubMed  CAS  Google Scholar 

  42. Kruger M: European hepatitis B immunoglobulin trials: prevention of recurrent hepatitis B after liver transplantation. Clin Transplant 2000, 14(Suppl 2):14–19.

    PubMed  Google Scholar 

  43. Papatheodoridis GV, Sevastianos V, Burroughs AK: Prevention of and treatment for hepatitis B virus infection after liver transplantation in the nucleoside analogues era. Am J Transplant 2003, 3:250–258.

    Article  PubMed  CAS  Google Scholar 

  44. Lok AS: Prevention of recurrent hepatitis B post-liver transplantation. Liver Transpl 2002, 8:S67-S73. Lok reports the importance of long-term therapy for the prevention of HBV recurrence in liver transplant patients.

    Article  PubMed  Google Scholar 

  45. Dienstag JL, Perrillo RP, Schiff ER, et al.: A preliminary trial of lamivudine for chronic hepatitis B infection. N Engl J Med 1995, 333:1657–1661.

    Article  PubMed  CAS  Google Scholar 

  46. Fontana RJ, Hann HW, Perrillo RP, et al.: Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. Gastroenterology 2002, 123:719–727.

    Article  PubMed  Google Scholar 

  47. Grellier L, Mutimer D, Ahmed M, et al.: Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet 1996, 348:1212–1215.

    Article  PubMed  CAS  Google Scholar 

  48. VierlingJM: Management of HBV Infection in liver transplantation patients. Int J Med Sci 2005, 2:41–49. This report does a very nice job of discussing and updating all of the treatment options for the liver transplant patient suffering from HBV.

    PubMed  CAS  Google Scholar 

  49. Marzano A, Lampertico P, Mazzaferro V, et al.: Prophylaxis of hepatitis B virus recurrence after liver transplantation in carriers of lamivudine-resistant mutants. Liver Transpl 2005, 11:532–538.

    Article  PubMed  Google Scholar 

  50. Kujawa M, Tillmann H, Hooman N, et al.: Detection of YMDD mutants before liver transplantation on HBVDNA positive patients is not associated with reinfections unless viral breakthrough has occurred. J Hepatol 2005, 42:S54.

    Article  Google Scholar 

  51. Locarnini S, Qi X, Arterburn S, et al.: Incidence and predictors of emergence of adefovir resistant HBV during four years of adefovir dipivoxil (ADV) therapy for patients with chronic hepatitis B (CHB). J Hepatol 2005, 42:17S.

  52. van Bommel F, Schernick A, Hopf U, Berg T: Tenofovir disoproxil fumarate exhibits strong antiviral effect in a patient with lamivudine-resistant severe hepatitis B reactivation [comment]. Gastroenterology 2003, 124:586–587.

    PubMed  Google Scholar 

  53. Neff GW, Nery J, Lau DT, et al.: Tenofovir therapy for lamivudine resistance following liver transplantation. Ann Pharmacother 2004, 38:1999–2004.

    Article  PubMed  CAS  Google Scholar 

  54. Safdar K, Neff G, Yoshida H, et al.: Treatment of lamivudine resistance hepatitis B patients after liver transplant: Results of a single center experience. Presented at AASLD, Boston; 2004.

  55. de VillaVH, Chen YS, Chen CL: Hepatitis B core antibodypositive grafts: recipient's risk. Transplantation 2003, 75:S49-S53.

    Article  PubMed  Google Scholar 

  56. Saab S, Chang AJ, Comulada S, et al.: Outcomes of hepatitis C- and hepatitis B core antibody-positive grafts in orthotopic liver transplantation. Liver Transpl 2003, 9:1053–1061.

    Article  PubMed  Google Scholar 

  57. Fabrega E, Garcia-Suarez C, Guerra A, et al.: Liver transplantation with allografts from hepatitis B core antibody-positive donors: a new approach. Liver Transpl 2003, 9:916–920.

    Article  PubMed  Google Scholar 

  58. Nery JR, Nery-Avila C, Reddy KR, et al.: Use of liver grafts from donors positive for antihepatitis B-core antibody (anti-HBc) in the era of prophylaxis with hepatitis-B immunoglobulin and lamivudine. Transplantation 2003, 75:1179–1186.

    Article  PubMed  CAS  Google Scholar 

  59. Yu AS, Vierling JM, Colquhoun SD, et al.: Transmission of hepatitis B infection from hepatitis B core antibody-positive liver allografts is prevented by lamivudine therapy [comment]. Liver Transpl 2001, 7:513–517.

    Article  PubMed  CAS  Google Scholar 

  60. Maguire D, Heaton ND, Smith HM: Failure of reactivation of hepatitis B after liver transplantation in hepatitis B surface antigen-negative, core antibody-positive recipients. Transplantation 2002, 73:481–482.

    Article  PubMed  Google Scholar 

  61. Markowitz JS, Martin P, Conrad AJ, et al.: Prophylaxis against hepatitis B recurrence following liver transplantation using combination lamivudine and hepatitis B immune globulin. Hepatology 1998, 28:585–589.

    Article  PubMed  CAS  Google Scholar 

  62. Nery JR, Weppler D, Rodriguez M, et al.: Efficacy of lamivudine in controlling hepatitis B virus recurrence after liver transplantation. Transplantation 1998, 65:1615–1621.

    Article  PubMed  CAS  Google Scholar 

  63. Marusawa H, Uemoto S, Hijikata M: Latent hepatitis B virus infection in healthy invididuals with antibodies to hepatitis B core antigen. Hepatology 2000, 31:488.

    Article  PubMed  CAS  Google Scholar 

  64. Van ThielDH, De Maria N, Colantoni A, Friedlander L: Can hepatitis B core antibody positive livers be used safely for transplantation: hepatitis B virus detection in the liver of individuals who are hepatitis B core antibody positive. Transplantation 1999, 68:519–522.

    Article  PubMed  Google Scholar 

  65. Dodson SF, Issa S, Araya V, et al.: Infectivity of hepatic allografts with antibodies to hepatitis B virus. Transplantation 1997, 64:1582–1584.

    Article  PubMed  CAS  Google Scholar 

  66. Uemoto S, Sugiyama K, Marusawa H, et al.: Transmission of hepatitis B virus from hepatitis B core antibodypositive donors in living related liver transplants. Transplantation 1998, 65:494–499.

    Article  PubMed  CAS  Google Scholar 

  67. The Italian Association for the Study of the Liver. http://www.webaisf.org/

  68. Franchello A, Ghisetti V, Marzano A, et al.: Transplantation of hepatitis B surface antigen-positive livers into hepatitis B virus-positive recipients and the role of hepatitis delta coinfection. Liver Transpl 2005, 11:922–928.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Cincinnati, 231 Albert Sabin Way, MSB Room 6560, 45267-0595, Cincinnati, OH, USA

    Guy W. Neff MD

Authors
  1. Marzia Montalbano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guy W. Neff MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guy W. Neff MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Montalbano, M., Neff, G.W. Management of recurrent viral hepatitis B and C after liver transplantation. Curr Gastroenterol Rep 8, 60–66 (2006). https://doi.org/10.1007/s11894-006-0065-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-006-0065-x

Keywords

Search

Navigation