Liver Transplantation in Hepatitis B/Hepatitis D (Delta) Virus Coinfected Recipients

Area of Science:

• Hepatology
• Virology
• Transplant Surgery

Background:

• Hepatitis D virus (HDV) causes the most severe form of viral hepatitis, rapidly progressing to cirrhosis.
• Liver transplantation is the sole therapeutic option for end-stage HDV disease, but access is limited in endemic regions.
• Hepatitis B virus (HBV) vaccination has reduced HDV prevalence in high-income countries, shifting transplant demand to older patients with prior HDV infection.

Purpose of the Study:

• To review the historical evolution and future prospects of liver transplantation for Hepatitis D.
• To analyze the progress in preventing HDV reinfection post-transplant.
• To explore cost-effective strategies for HDV prophylaxis by reassessing immunoglobulin use.

Main Methods:

• Literature review of liver transplantation for HDV from 1987 to present.
• Analysis of current prophylaxis protocols for HDV reinfection.
• Evaluation of the role of hepatitis B surface antigen immunoglobulins and antivirals.

Main Results:

• Liver transplantation has evolved significantly for HDV, with ongoing improvements in outcomes.
• Current standard prophylaxis involves indefinite combination therapy with HBV antivirals and anti-HBs immunoglobulins.
• The biology of HDV suggests potential for optimizing prophylaxis, possibly reducing immunoglobulin requirements and costs.

Conclusions:

• Liver transplantation remains crucial for terminal HDV, with a history of evolving techniques and outcomes.
• Prophylaxis against HDV reinfection is successful but can be optimized for cost-effectiveness.
• Future strategies may involve tailored immunoglobulin administration based on HDV biology to reduce treatment burdens.