[Liver transplantation for chronic hepatitis B]

Area of Science:

• Hepatology
• Virology
• Transplantation Immunology

Context:

• Hepatitis B virus (HBV) infection accounts for 5-10% of European liver transplantations.
• Prognosis post-transplant hinges on preventing HBV graft reinfection, with risk correlating to pre-transplant HBV viral load.
• Existing prophylaxis includes anti-HBs immune globulins (HBIG) or lamivudine, effective in patients without active HBV replication.

Purpose:

• To evaluate the efficacy of pre- and post-transplant strategies in preventing HBV graft reinfection.
• To assess the role of antiviral therapies and HBIG in managing HBV recurrence risk.
• To determine optimal prophylaxis regimens for liver transplant recipients with HBV-related liver disease.

Summary:

• Antiviral agents (lamivudine, adefovir, entecavir, tenofovir) control HBV replication in patients awaiting transplant.
• Post-transplant combination therapy with antivirals and HBIG is highly effective, reducing HBV reinfection rates below 10%, even with pre-transplant replication.
• New nucleos(t)ide analogues have improved outcomes, with current 5-year survival reaching 85% for HBV-related liver disease post-transplantation.

Impact:

• The combined prophylaxis strategy significantly lowers HBV reinfection rates, improving long-term survival for liver transplant recipients.
• This approach enhances the overall prognosis for patients undergoing liver transplantation due to HBV-related liver disease.
• Further research is evaluating the potential to discontinue HBIG long-term while maintaining antiviral treatment or vaccination.