Hepatitis B Virus Infection and Organ Transplantation

Hepatitis B virus (HBV) infection remains an important cause of liver disease and continues to present several unique challenges in organ transplantation despite the availability of an effective vaccine to prevent HBV infection and the introduction of oral therapy to treat HBV infection over 20 years ago. HBV recurrence following liver transplantation can now be prevented with antiviral therapy, although controversy persists as to whether immunoprophylaxis with hepatitis B immunoglobulin is also necessary. HBV reactivation following organ transplantation can occur even in recipients with absent hepatitis B surface antigen at the time of transplantation and remains an important cause of morbidity and mortality. Expansion of the donor pool by using organs from hepatitis B core antibody-positive donors can result in HBV infection in the recipient. Another challenge is severe HBV reactivation leading to liver failure in HBV-infected patients receiving immunomodulatory agents, which are increasingly being used for a variety of nonneoplastic indications.