The prevention of viral recurrence in the long term

Dig Liver Dis. 2009 May;41 Suppl 2:S195-7. doi: 10.1016/S1590-8658(09)60444-8.


The transplantation outcome depends largely on the prevention of hepatitis B recurrence. The spontaneous risk of HBV reinfection exceeds 75%, but major advances in prophylaxis during the last 15 years have led to the control of post-transplant hepatitis B reinfection in more than 90% of HBV transplants. Treatment with hepatitis B immune globulins (HBIG) plays a major role in prophylaxis, either as monotherapy in non-replicating patients or in combination with antiviral drugs in replicating subjects. Although no standardized therapeutic protocols have been defined, at present the prevailing approach is to use high-dose intravenous HBIG in the immediate perioperative period (first week, induction phase) and to administer over the long term monthly fixed or on-demand doses of intravenous or intramuscular HBIG (maintenance therapy), in association with antiviral(s). Results have been excellent, yet different strategies of long-term prophylaxis have been proposed in order to simplify therapy and reduce costs. Long-term prophylaxis with antiviral(s) and low-dose intramuscular HBIG seems to be the most promising option; in stable patients, the combination with antiviral agents reduces the need of HBIG, in particular when using on-demand administration protocols and intramuscular HBIG has proven as effective and safe as intravenous preparations during the maintenance phase.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / administration & dosage
  • Clinical Protocols
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Hepatitis B / prevention & control*
  • Hepatitis B / surgery*
  • Humans
  • Immunoglobulins / administration & dosage
  • Liver Transplantation*
  • Perioperative Care / economics
  • Perioperative Care / methods*
  • Perioperative Care / trends
  • Postoperative Complications / prevention & control*
  • Secondary Prevention
  • Treatment Outcome


  • Antiviral Agents
  • Immunoglobulins
  • hepatitis B hyperimmune globulin