Hepatitis C and B in liver transplantation

Area of Science:

• Hepatology
• Transplantation Immunology
• Infectious Diseases

Background:

• Hepatitis B and C recurrence significantly impacts liver transplant outcomes.
• Hepatitis B virus (HBV) recurrence risk is linked to viral load and donor/recipient serological status.
• Hepatitis C virus (HCV) infection recurs in over 90% of liver transplant recipients, often causing post-transplant hepatitis.

Purpose of the Study:

• To review the current challenges and future directions in managing hepatitis B and C post-liver transplantation.
• To explore the efficacy of hepatitis B immune globulin (HBIg) and antivirals for HBV prevention.
• To assess strategies for reducing HCV acquisition and recurrence after liver transplantation.

Main Methods:

• Literature review and synthesis of current knowledge on HBV and HCV recurrence after liver transplantation.
• Analysis of the role of HBIg, antiviral therapies, and donor screening in managing post-transplant hepatitis.
• Discussion of future research needs and the impact of healthcare policies on transplantation eligibility.

Main Results:

• HBIg efficacy and optimal patient selection for HBV prophylaxis require further definition.
• Antiviral effects on post-transplant hepatitis B and HBV recurrence prevention are yet to be determined.
• Newer HCV screening may reduce acquisition, but antiviral impact and recurrence prevention strategies need study.

Conclusions:

• The optimal use of HBIg and the role of antivirals in preventing HBV recurrence after liver transplant remain areas for investigation.
• Future research should focus on developing effective antiviral regimens for preventing HCV recurrence and acquisition.
• Healthcare policies, such as Medicare exclusions for HBsAg-positive patients, influence transplantation access and future strategies.