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Contradictory immune response in post liver transplantation hepatitis B and C
Akinobu Takaki1, Takahito Yagi2, Kazuhide Yamamoto1
1Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
Insights
Orthotopic liver transplantation (OLT) for Hepatitis B and C requires managing immune responses to prevent recurrence. Strategies include immunoglobulin, antivirals, and vaccines, with varying success in controlling viral reactivation post-transplant.
Area of Science:
- Hepatology
- Immunology
- Transplantation
Background:
- Hepatitis B and C can lead to decompensated liver cirrhosis, necessitating orthotopic liver transplantation (OLT).
- Recurrence of hepatitis B and C post-OLT poses significant challenges to graft survival and patient outcomes.
- Current management strategies for post-OLT hepatitis B involve hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues, while hepatitis C recurrence is common and difficult to treat.
Purpose of the Study:
- To review the adaptive immune response in patients undergoing orthotopic liver transplantation for hepatitis B and C.
- To explore the efficacy of current and novel therapeutic strategies in controlling viral recurrence post-OLT.
- To understand the role of immune responses in the varying severity of hepatitis C reinfection after OLT.
Main Methods:
- Literature review of studies on adaptive immunity in post-OLT hepatitis B and C.
- Analysis of treatment outcomes for hepatitis B recurrence using HBIG, nucleos(t)ide analogues, and vaccines.
- Examination of immune response modulation in controlling hepatitis C reinfection post-transplant.
Main Results:
- Hepatitis B recurrence is clinically controlled with HBIG and nucleos(t)ide analogues, with vaccine-induced antibody production being an alternative for select patients.
- Hepatitis C virus (HCV) reinfection occurs in over 90% of transplanted livers, with diverse clinical presentations.
- Interferon treatment for recurrent hepatitis C has limited success and carries risks, highlighting the need for better immune management.
Conclusions:
- Managing adaptive immune responses is crucial for controlling viral hepatitis recurrence after OLT.
- Novel strategies, including vaccine-induced immunity and tailored immunosuppression, show promise for managing post-transplant hepatitis B.
- Further research into immune modulation is essential for improving outcomes in patients with recurrent hepatitis C post-OLT.
Abstract:
Hepatitis B and C often progress to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT). After OLT, hepatitis B recurrence is clinically controlled with a combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues. Another approach is to induce self-producing anti-hepatitis B virus (HBV) antibodies using a HBV envelope antigen vaccine. Patients who had not been HBV carriers such as acutely infected liver failure or who received liver from HBV self-limited donor are good candidate. For chronic HBV carrier patients, a successful response can only be achieved in selected patients such as those treated with experimentally reduced immunosuppression protocols or received an anti-HBV adaptive memory carrying donor liver. Hepatitis C virus (HCV) reinfects transplanted livers at a rate of >90%. HCV reinfected patients show different severities of hepatitis, from mild and slowly progressing to severe and rapidly progressing, possibly resulting from different adaptive immune responses. More than half the patients require interferon treatment, although the success rate is low and carries risks for leukocytopenia and rejection. Managing the immune response has an important role in controlling recurrent hepatitis C. This study aimed to review the adaptive immune response in post-OLT hepatitis B and C.
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