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Published on: September 25, 2019
Management of hepatitis B virus infection after liver transplantation
Miguel Jiménez-Pérez1, Rocío González-Grande1, José Mostazo Torres1
1Miguel Jiménez-Pérez, Rocío González-Grande, José Mostazo Torres, Carolina González Arjona, Liver Transplantation and Hepatology Unit, UGC de Aparato Digestivo Hospital Regional Universitario, 29010 Malaga, Spain.
Insights
Hepatitis B virus (HBV) liver transplants are now successful with prophylaxis. New antiviral drugs and personalized strategies improve outcomes, even with HBV-positive donors.
Area of Science:
- Hepatology
- Virology
- Transplantation Immunology
Background:
- Chronic hepatitis B virus (HBV) infection is a leading cause of liver cirrhosis and hepatocellular carcinoma.
- Liver transplantation (LT) is the primary treatment for end-stage liver failure due to HBV.
- Preventing viral reactivation post-transplant is crucial for successful outcomes.
Purpose of the Study:
- To review the evolution and current strategies for prophylactic treatment against post-transplant HBV recurrence.
- To highlight the impact of hepatitis B immunoglobulin (HBIG) and oral antiviral agents on transplant success.
- To discuss emerging prophylactic regimens and personalized approaches for HBV-infected transplant recipients.
Main Methods:
- Review of historical and current prophylactic treatments for HBV in LT.
- Analysis of the efficacy of HBIG, lamivudine, entecavir, and tenofovir.
- Examination of strategies for utilizing anti-HBc-positive donors in LT.
Main Results:
- Prophylaxis with HBIG and oral antivirals has significantly improved 5-year survival rates post-LT for CHB (from 45% to 85%).
- Newer oral agents like entecavir and tenofovir offer potent prophylaxis with reduced resistance.
- Personalized prophylaxis and regimens for anti-HBc-positive donors enhance transplant feasibility.
Conclusions:
- LT for chronic hepatitis B is a viable and successful treatment option due to advancements in prophylaxis.
- The combination of potent oral antivirals and HBIG, or monotherapy with newer agents, forms the basis of modern prophylactic strategies.
- Personalized risk assessment and adapted regimens enable successful transplantation even when using organs from anti-HBc-positive donors.
Abstract:
Chronic hepatitis B virus (HBV) infection is responsible for up to 30% of cases of liver cirrhosis and up to 53% of cases of hepatocellular carcinoma. Liver transplantation (LT) is the best therapeutic option for patients with end-stage liver failure caused by HBV. The success of transplantation, though, depends on receiving prophylactic treatment against post-transplant viral reactivation. In the absence of prophylaxis, liver transplantation due to chronic hepatitis B (CHB) is associated with high rates of viral recurrence and poor survival. The introduction of treatment with hepatitis B immunoglobulins (HBIG) during the 1990s and later the incorporation of oral antiviral drugs have improved the prognosis of these patients. Thus, LT for CHB is now a universally accepted option, with an estimated 5 years survival of around 85% vs the 45% survival seen prior to the introduction of HBIG. The combination of lamivudine plus HBIG has for many years been the most widely used prophylactic regimen. However, with the appearance of new more potent oral antiviral agents associated with less resistance (e.g., entecavir and tenofovir) for the treatment of CHB, new prophylactic strategies are being designed, either in combination with HBIG or alone as a monotherapy. These advances have allowed for more personalized prophylaxis based on the individual risk profile of a given patient. In addition, the small pool of donors has required the use of anti-HBc-positive donors (with the resulting possibility of transmitting HBV from these organs), which has been made possible by suitable prophylactic regimens.
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