[Liver transplantation in patients with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus]

The current 5-year survival rate after liver transplantation for hepatitis B virus HBV-related liver disease is excellent (85 %) because of excellent prophylaxis against HBV reinfection, obtained by the combination of antiviral therapy before transplantation and both anti-HBs immunoglobulin and antiviral therapy afterwards. End-stage liver disease due to hepatitis C virus (HCV) is a major indication for liver transplantation. Results are not as good (65%) because HCV reinfection after transplantation is almost impossible to prevent, and it impairs patient and graft survival. Combination therapy with pegylated interferon and ribavirin must be administered at an early stage of HCV recurrence on the graft. Liver transplantation is feasible for HIV-infected patients. Results are excellent for HIV/HBV coinfected patients (100%). In HIV/HCV coinfected patients, however, the recurrence of HCV infection is more severe than in patients with HCV alone and survival thus lower. Very early anti-HCV therapy must be discussed.