15. Liver Transplantation for Chronic Hepatitis B and C

  1. Howard C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci2,
  2. Anna S.F. Lok MD3,
  3. Stephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath4 and
  4. Arie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci5
  1. Ed Gane

Published Online: 26 JUL 2013

DOI: 10.1002/9781118637272.ch15

Viral Hepatitis, Fourth Edition

Viral Hepatitis, Fourth Edition

How to Cite

Gane, E. (2013) Liver Transplantation for Chronic Hepatitis B and C, in Viral Hepatitis, Fourth Edition (eds H. C. Thomas, A. S.F. Lok, S. A. Locarnini and A. J. Zuckerman), John Wiley & Sons, Ltd, Oxford, UK. doi: 10.1002/9781118637272.ch15

Editor Information

  1. 2

    Emeritus Professor of Hepatology, Department of Medicine, Imperial College London, London, UK

  2. 3

    Alice Lohrman Andrews Research Professor in Hepatology, Director of Clinical Hepatology, Professor of Internal Medicine, Associate Chair for Clinical Research, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA

  3. 4

    Head, Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia

  4. 5

    Emeritus Professor of Medical Microbiology, Formerly Principal and Dean, Royal Free Hospital School of Medicine

Author Information

  1. New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand

Publication History

  1. Published Online: 26 JUL 2013

ISBN Information

Print ISBN: 9780470672952

Online ISBN: 9781118637272

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Keywords:

  • recurrent hepatitis C;
  • pegylated interferon;
  • ribavirin;
  • protease inhibitor;
  • IL28B;
  • recurrent hepatitis B;
  • hepatitis B immunoglobulin;
  • nucelos(t)ide analog

Summary

Chronic hepatitis C is the leading cause of liver transplantation globally. Recurrence of hepatitis C virus (HCV) infection is universal and is associated with rapid progression with reduced graft and patient survival.Successful antiviral therapy is the only factor associated with improved graft and patient survival following transplantation for hepatitis C. However, the combination of pegylated interferon (PEG-IFN) and ribavirin (RBV) has poor efficacy and tolerability in transplant recipients. Baseline predictors of response include HCV genotype 2/3, early fibrosis stage, and IL28B genotype CC. Early on-treatment responses are also useful. Direct-acting antivirals may provide new opportunities for treatment of established recurrence and prevention of recurrent infection.Chronic hepatitis B is the leading cause of liver transplantation in Asia. Without antiviral prophylaxis, hepatitis B virus (HBV) infection recurs in more than 80%. High-dose intravenous hepatitis B immune globulin (HBIG) reduces recurrence by 60%, but is expensive and less effective in patients who are HBVDNA–positive at the time of transplant. Adding a nucleos(t)ide analog reduces recurrence to <5%. Substitution by low-dose IM HBIG is safe and effective, and is associated with improved quality of life.HBIG minimization and avoidance strategies have been developed to reduce the cost and inconvenience of monthly HBIG administration. Late HBIG withdrawal is successful in low-risk patients who continue oral antiviral therapy. HBIG avoidance may be feasible in patients treated with combination nucleos(t)ide analogs from the time of listing.