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Hepatitis B and liver transplantation: 2008 update
Susanne Beckebaum1, Georgios C Sotiropoulos, Guido Gerken
1Department of Gastroenterology and Hepatology, University Hospital Essen, Germany. susanne.beckebaum@uni-due.de
Reviews in Medical Virology
|September 26, 2008
Summary
Suppression of hepatitis B virus (HBV) replication is crucial before and after liver transplantation (LT). Newer nucleos(t)ide analogues and combination therapies show promise for preventing HBV recurrence post-LT, potentially replacing hepatitis B immune globulin (HBIG).
Area of Science:
- Hepatology
- Virology
- Transplantation Immunology
Background:
- Hepatitis B virus (HBV) recurrence post-liver transplantation (LT) necessitates viral suppression to undetectable levels.
- Lamivudine (LAM) has historical data, but resistance is a concern.
- Adefovir dipivoxil (ADV) add-on therapy improved outcomes in LAM-resistant pre-transplant patients.
Purpose of the Study:
- To review current and emerging treatment strategies for preventing HBV recurrence after LT.
- To evaluate the efficacy of newer nucleos(t)ide analogues and combination therapies.
- To explore alternatives to hepatitis B immune globulin (HBIG) therapy.
Main Methods:
- Review of published data on antiviral therapies for HBV in pre- and post-LT settings.
- Analysis of newer nucleos(t)ide analogues (entecavir, tenofovir, telbivudine) with lower resistance rates.
- Examination of combined hepatitis B immune globulin (HBIG) and nucleos(t)ide analogue strategies.
- Discussion of active immunization and adoptive immune transfer.
Main Results:
- Newer nucleos(t)ide analogues demonstrate higher potency and lower resistance than LAM.
- Combined HBIG and nucleos(t)ide analogue therapy is the current standard for preventing HBV recurrence post-LT.
- Alternative strategies like active immunization and nucleos(t)ide analogue combinations are under investigation.
Conclusions:
- Nucleos(t)ide analogue combination therapies may offer a cost-effective alternative to HBIG.
- Further controlled clinical studies are essential to assess the safety and efficacy of novel combination regimens.
- Optimizing long-term post-LT HBV management requires continued research into advanced antiviral strategies.
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