Liver transplantation for hepatitis B virus. Pre-emptive and peri-operative prophylaxis

Dig Liver Dis. 2009 May;41 Suppl 2:S191-4. doi: 10.1016/S1590-8658(09)60443-6.

Abstract

In the past, reinfection of the graft by hepatitis B virus (HBV) after liver transplantation for HBV-related liver disease was often followed by severe liver damage and reduced survival. The long-term administration of hepatitis B immunoglobulin (HBIG) dramatically reduced this risk. However, this procedure was ineffective in most patients with active viral replication pre-transplant. The use of lamivudine in the pre-transplant setting partially solved this problem. The emergence of resistant mutants to lamivudine was also solved by the addition of adefovir. At present, combination therapy by oral antivirals pre-transplant and HBIG plus the same drugs post-transplant achieves nearly 100% of protection against graft reinfection. In a recent study, a new intravenous HBIG, Niuliva has shown high efficacy in achieving protective anti-HBs levels after liver transplantation for HBV-related liver diseases, as well as a good safety profile. Using combination therapies, the doses of HBIG can be reduced or even stopped after several weeks or months post-transplant, continuing with oral antivirals alone. The recently introduced antivirals achieve a very high antiviral potency and low risk of resistance. This may further increase the efficacy in preventing graft reinfection in the post-liver transplantation setting.

Publication types

  • Review

MeSH terms

  • Adenine / administration & dosage
  • Adenine / analogs & derivatives
  • Antiviral Agents / administration & dosage
  • DNA, Viral / blood
  • DNA, Viral / isolation & purification
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Hepatitis B / prevention & control*
  • Hepatitis B / surgery*
  • Hepatitis B / virology
  • Hepatitis B virus / isolation & purification
  • Humans
  • Immunoglobulins / administration & dosage
  • Lamivudine / administration & dosage
  • Liver Transplantation*
  • Organophosphonates / administration & dosage
  • Perioperative Care / methods
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / virology
  • Secondary Prevention
  • Treatment Outcome

Substances

  • Antiviral Agents
  • DNA, Viral
  • Immunoglobulins
  • Organophosphonates
  • Lamivudine
  • adefovir
  • Adenine
  • hepatitis B hyperimmune globulin