Liver transplantation for chronic viral hepatitis

A better understanding of the mechanism of viral replication and of viral transmission has led to improved results with OLTx for patients with end-stage liver disease caused by viral hepatitis. Patients with hepatitis-B-related liver disease who are HBV-DNA negative can expect excellent survival after OLTx with long-term HBIG therapy. Patients coinfected with HDV who are HBV-DNA negative can also expect an excellent rate of survival. HBV-DNA-positive patients may benefit from the addition of lamivudine to the prophylactic regimen both before and after OLTx. De novo HBV infections generally have a very benign course. Lamivudine has proven to be very effective in the treatment of both de novo and recurrent HBV infection after OLTx; however, resistance can develop. Allografts from donors with antibodies to HBV can be used most effectively when directed to recipients who also harbor HBV antibodies. The recurrence of HCV infection after OLTx is universal; however, the 5-year survival rate in patients who received OLTx for HCV-related liver disease is not diminished. Although a few patients experience an aggressive recurrence of HCV infection after OLTx, prognostic indicators have not been determined to allow for identification of these patients. Alpha-interferon does not seem to be effective in the treatment of recurrent HCV infection after OLTx. Trials with combination alpha-interferon-ribavirin are underway. Retransplantation for HCV-related allograft failure can be performed safely in patients if performed before the onset of other organ system failure. Finally, anti-HCV-positive recipients of allografts from anti-HCV-positive donors have an excellent 5-year survival rate.