Management of hepatitis B in liver transplant patients

Recent therapeutic advances have allowed for routine transplantation of patients with hepatitis B. The first major breakthrough was the use of hepatitis B immune globulin, which reduced posttransplantation hepatitis B recurrence rates to approximately 20%. More recently, the nucleoside analogues lamivudine and adefovir have shown efficacy in the treatment of hepatitis B both before and after liver transplantation. Management strategies are evolving that include initiation of a nucleoside analogue pretransplantation in patients with active viral replication. Combination therapy with hepatitis B immune globulin and a nucleoside analogue is being used posttransplantation. In addition, there is interest in the use of therapeutic vaccination posttransplantation. In this report, we review strategies for managing HBV in the setting of liver transplantation and detail data regarding patient outcomes.