Hepatitis viruses and liver transplantation

Area of Science:

• Hepatology and Transplant Surgery
• Viral Hepatitis Research
• Immunoprophylaxis and Antiviral Therapy

Background:

• Hepatitis B virus (HBV) and hepatitis C virus (HCV) are primary indications for liver transplantation.
• Viral recurrence post-transplantation is a significant limitation, impacting graft and patient survival.
• Hepatitis delta virus (HDV) coinfection presents unique challenges in transplantation outcomes.

Purpose of the Study:

• To evaluate the risks and outcomes of HBV and HCV reinfection after liver transplantation.
• To assess the efficacy of immunoprophylaxis and antiviral treatments in preventing viral recurrence.
• To analyze long-term survival rates in patients transplanted for viral hepatitis-related cirrhosis.

Main Methods:

• Analysis of post-transplant outcomes in patients receiving liver grafts for HBV, HDV, and HCV cirrhosis.
• Evaluation of hepatitis B immunoglobulin (anti-HB) prophylaxis and antiviral regimens (ganciclovir, famciclovir, lamivudine).
• Monitoring of viral load (HBV DNA, HCV RNA) and clinical presentation of hepatitis recurrence.

Main Results:

• HBV recurrence risk is high without prophylaxis (80%), reduced by anti-HB (30% for cirrhosis, <10% for fulminant hepatitis).
• HDV recurrence is high (80%) with anti-HB prophylaxis but clinically insignificant without HBV coinfection.
• HCV reinfection is nearly universal (90% HCV-RNA positive), with acute hepatitis in 75% of cases; 5-year survival for HCV cirrhosis is 78%.

Conclusions:

• Liver transplantation is viable for HBV cirrhosis without active replication; long-term anti-HB prophylaxis is crucial for preventing HBV recurrence.
• Patients with active HBV replication require combined antiviral therapy and immunoprophylaxis.
• HCV reinfection is frequent, and while medium-term survival is good, effective prevention and treatment strategies are urgently needed.