Viral hepatitis after liver transplantation: A brief overview

Liver transplantation (LT) remains the only curative therapy in patients with end stage liver disease. With improvement in surgical techniques and immunosuppression protocols, both 1-year and 5-year survival have improved significantly. Similarly, recurrent hepatitis B virus and hepatitis C virus infection and consequent graft failure have become a thing of the past in the last few decades with the availability of highly effective nucleotide analogues and directly acting antivirals, respectively. However, infection with non-hepatotrophic viruses (e.g., cytomegalovirus and Epstein-Barr virus) remains an important cause of graft failure and rejection, leading to increased morbidity and mortality. Chronic hepatitis E virus infection is also an emerging cause of viral hepatitis and liver failure in these patients. The key to successful management is early diagnosis and institution of appropriate antiviral therapy. In addition, the immunosuppression must be modified to maintain a balance between aggravating viral infection and rejection. The key purpose of this article is to provide an updated overview of various hepatotropic and non-hepatotropic viral hepatitis in patients undergoing LT. Risk factors, Clinical presentation, and diagnosis of viral hepatitis in LT settings will be discussed in detail. Recurrent hepatitis B virus and hepatitis C virus infection in transplanted grafts will also be described. Finally, the use of vaccination and immunoglobulin to prevent the development of these infections will also be described.