Abstract
Background
Twenty years ago, liver transplantation for hepatitis B had been a relative contraindication to universal HBV recurrence and poor outcomes. Over the ensuing two decades, there has been refinement of prevention strategies in order to minimize HBV recurrence in the allograft.
Results
Currently, the most efficacious and cost-effective strategies include newer oral antiviral drugs in combination with low doses of hepatitis B immunoglobulin (HBIG). More recently, strategies have been successful in withdrawing HBIG and newer approaches of HBIG avoidance are currently under development.
Conclusion
Thus, 20 years afterward, HBV recurrence is <5% and outcomes following liver transplantation are excellent.
Similar content being viewed by others
References
Maddrey WC. Hepatitis B: an important public health issue. J Med Virol 2000;61:362–326
El-Serag HB, Davila JA, Petersen NJ, et al. The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med 2003;139:817–823
Lake JR. Do we really need long-term hepatitis B hyperimmune globulin? What are the alternatives? Liver Transpl 2008;14:S23–S26
Degertekin B, Han SH, Keeffe EB, et al. Impact of virologic breakthrough and HBIG regimen on hepatitis B recurrence after liver transplantation. Am J Transplant 1823;10:1823–1833
Marcellin P, Samuel D, Areias J, et al. Pretransplantation interferon treatment and recurrence of hepatitis B virus infection after liver transplantation for hepatitis B-related end-stage liver disease. Hepatology 1994; (1):6–12
Zoulim F, Radenne S, Ducerf C. Management of patients with decompensated hepatitis B virus associated [corrected] cirrhosis. Liver Transpl 2008;14:S1–S7
Hann HW, Fontana RJ, Wright T, et al. A United States compassionate use study of lamivudine treatment in nontransplantation candidates with decompensated hepatitis B virus-related cirrhosis. Liver Transpl 2003;9:49–56
Yao FY, Terrault NA, Freise C, et al. Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort. Hepatology 2001;34:411–416
Villeneuve JP, Condreay LD, Willems B, et al. Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B. Hepatology 2000;31:207–210
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
Lok AS. How to diagnose and treat hepatitis B virus antiviral drug resistance in the liver transplant setting. Liver Transpl 2008;14:S8–S14
Liaw YF, Sung JJ, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521–1531
Schiff E, Lai CL, Hadziyannis S, et al. Adefovir dipivoxil for wait-listed and post-liver transplantation patients with lamivudine-resistant hepatitis B: final long-term results. Liver Transpl 2007;13:349–360
Schiff ER, Lai CL, Hadziyannis S, et al. Adefovir dipivoxil therapy for lamivudine-resistant hepatitis B in pre- and post-liver transplantation patients. Hepatology 2003;38:1419–1427
Woo G, Tomlinson G, Nishikawa Y, et al. Tenofovir and entecavir are the most effective antiviral agents for chronic hepatitis B: a systematic review and Bayesian meta-analyses. Gastroenterology 2010;139:1218–1229
Liaw YF, Sheen IS, Lee CM, et al. Tenofovir disoproxil fumarate (TDF), emtricitabine/TDF, and entecavir in patients with decompensated chronic hepatitis B liver disease. Hepatology 2011;53:62–72
Garg H, Sarin SK, Kumar M, et al. (2011) Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. Hepatology
Shim JH, Lee HC, Kim KM, et al. Efficacy of entecavir in treatment-naive patients with hepatitis B virus-related decompensated cirrhosis. J Hepatol 2009;52:176–182
Lange CM, Bojunga J, Hofmann WP, et al. Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function. Hepatology 2009;50(6):2001–2016
Wong VW, Wong GL, Yiu KK, et al. Entecavir treatment in patients with severe acute exacerbation of chronic hepatitis B. J Hepatol 2011;54(2):236–242
Liaw YF, Raptopoulou-Gigi M, Cheinquer H, et al. (2011) Efficacy and safety of entecavir versus adefovir in chronic hepatitis B patients with hepatic decompensation: a randomized open-label study. Hepatology
Samuel D, Bismuth A, Mathieu D, et al. Passive immunoprophylaxis after liver transplantation in HBsAg-positive patients. Lancet 1991;337:813–815
Samuel D, Muller R, Alexander G, et al. Liver transplantation in European patients with the hepatitis B surface antigen. N Engl J Med 1993;329:1842–1847
Angus PW, Locarnini SA, McCaughan GW, et al. Hepatitis B virus precore mutant infection is associated with severe recurrent disease after liver transplantation. Hepatology 1995;21:14–18
McMillan JS, Bowden DS, Angus PW, et al. Mutations in the hepatitis B virus precore/core gene and core promoter in patients with severe recurrent disease following liver transplantation. Hepatology 1996;24:1371–1378
Mutimer D, Pillay D, Dragon E, et al. High pre-treatment serum hepatitis B virus titre predicts failure of lamivudine prophylaxis and graft re-infection after liver transplantation. J Hepatol 1999;30:715–721
Grellier L, Mutimer D, Ahmed M, et al. Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet 1996;348:1212–1215
Perrillo RP, Wright T, Rakela J, et al. A multicenter United States-Canadian trial to assess lamivudine monotherapy before and after liver transplantation for chronic hepatitis B. Hepatology 2001;33:424–432
Lo CM, Fung JT, Lau GK, et al. Development of antibody to hepatitis B surface antigen after liver transplantation for chronic hepatitis B. Hepatology 2003;37:36–43
Luo Y, Lo CM, Cheung CK, et al. Identification of hepatitis B virus-specific lymphocytes in human liver grafts from HBV-immune donors. Liver Transpl 2007;13:71–79
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
Marzano A, Salizzoni M, Debernardi-Venon W, et al. Prevention of hepatitis B virus recurrence after liver transplantation in cirrhotic patients treated with lamivudine and passive immunoprophylaxis. J Hepatol 2001;34:903–910
Han SH, Ofman J, Holt C, et al. An efficacy and cost-effectiveness analysis of combination hepatitis B immune globulin and lamivudine to prevent recurrent hepatitis B after orthotopic liver transplantation compared with hepatitis B immune globulin monotherapy. Liver Transpl 2000;6(6):741–748
Angus PW, McCaughan GW, Gane EJ, et al. Combination low-dose hepatitis B immune globulin and lamivudine therapy provides effective prophylaxis against posttransplantation hepatitis B. Liver Transpl 2000;6:429–433
Gane EJ, Angus PW, Strasser S, et al. Lamivudine plus low-dose hepatitis B immunoglobulin to prevent recurrent hepatitis B following liver transplantation. Gastroenterology 2007;132:931–937
Karademir S, Astarcioglu H, Akarsu M, et al. Prophylactic use of low-dose, on-demand, intramuscular hepatitis B immunoglobulin and lamivudine after liver transplantation. Transplant Proc 2006;38:579–583
Takaki A, Yagi T, Iwasaki Y, et al. Short-term high-dose followed by long-term low-dose hepatitis B immunoglobulin and lamivudine therapy prevented recurrent hepatitis B after liver transplantation. Transplantation 2007;83:231–233
Nath DS, Kalis A, Nelson S, et al. Hepatitis B prophylaxis post-liver transplant without maintenance hepatitis B immunoglobulin therapy. Clin Transplant 2006;20:206–210
Angus PW, Patterson SJ, Strasser SI, et al. A randomized study of adefovir dipivoxil in place of HBIG in combination with lamivudine as post-liver transplantation hepatitis B prophylaxis. Hepatology 2008;48:1460–1466
Saab S, Desai S, Tsaoi D, et al. Posttransplantation Hepatitis B Prophylaxis with Combination Oral Nucleoside and Nucleotide Analog Therapy. Am J Transplant 2011;7:1600–6143
Cheung CK, Lo CM, Man K, et al. Occult hepatitis B virus infection of donor and recipient origin after liver transplantation despite nucleoside analogue prophylaxis. Liver Transpl 2010;16:1314–1323
Angelico M, Di Paolo D, Trinito MO, et al. Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis. Hepatology 2002;35(1):176–181
Bienzle U, Gunther M, Neuhaus R, et al. Immunization with an adjuvant hepatitis B vaccine after liver transplantation for hepatitis B-related disease. Hepatology 2003;38:811–819
Lo CM, Liu CL, Chan SC, et al. Failure of hepatitis B vaccination in patients receiving lamivudine prophylaxis after liver transplantation for chronic hepatitis B. J Hepatol 2005;43:283–287
Wadhawan M, Gupta S, Vij V, et al. Living related liver transplant (LRLT) in HBV DNA negative cirrhosis without hepatitis B immunoglobulin (HBIG). Hepatol Int 2011;5:38
Saab S, Waterman B, Chi AC, et al. Comparison of different immunoprophylaxis regimens after liver transplantation with hepatitis B core antibody-positive donors: a systematic review. Liver Transpl 2010;16:300–307
Cholongitas E, Papatheodoridis GV, Burroughs AK. Liver grafts from anti-hepatitis B core positive donors: a systematic review. J Hepatol 2010;52:272–279
Pascarella S, Negro F, Hepatitis D. virus: an update. Liver Int 2010;31:7–21
Wedemeyer H, Yurdaydin C, Dalekos GN, et al. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med 2011;364:322–331
Samuel D, Zignego AL, Reynes M, et al. Long-term clinical and virological outcome after liver transplantation for cirrhosis caused by chronic delta hepatitis. Hepatology 1995;21:333–339
Faria LC, Gigou M, Roque-Afonso AM, et al. Hepatocellular carcinoma is associated with an increased risk of hepatitis B virus recurrence after liver transplantation. Gastroenterology 2008;134:1890–1899 (quiz 2155)
Saab S, Yeganeh M, Nguyen K, et al. Recurrence of hepatocellular carcinoma and hepatitis B reinfection in hepatitis B surface antigen-positive patients after liver transplantation. Liver Transpl 2009;15:1525–1534
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McCaughan, G.W. Prevention of post liver transplant HBV recurrence. Hepatol Int 5, 876–881 (2011). https://doi.org/10.1007/s12072-011-9293-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12072-011-9293-8