37. Liver Transplantation in Patients with Hepatitis B, C or HIV Infection

  1. James S. Dooley MD, FRCP2,3,
  2. Anna S. F. Lok MBBS, MD, FRCP4,
  3. Andrew K. Burroughs FRCP, FMedSci3,5 and
  4. E. Jenny Heathcote MB BS, MD, FRCP, FRCP(C)6,7
  1. Norah Terrault MD, MPH

Published Online: 5 MAY 2011

DOI: 10.1002/9781444341294.ch37

Sherlock's Diseases of the Liver and Biliary System, 12th Edition

Sherlock's Diseases of the Liver and Biliary System, 12th Edition

How to Cite

Terrault, N. (2011) Liver Transplantation in Patients with Hepatitis B, C or HIV Infection, in Sherlock's Diseases of the Liver and Biliary System, 12th Edition (eds J. S. Dooley, A. S. F. Lok, A. K. Burroughs and E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444341294.ch37

Editor Information

  1. 2

    Centre for Hepatology, University College London Medical School, UK

  2. 3

    Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK

  3. 4

    Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA

  4. 5

    University College London, London, UK

  5. 6

    Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ontario, Canada

  6. 7

    Patient Based Clinical Research, Toronto Western Hospital Research Institute, Toronto, Ontario, Canada

Author Information

  1. Division of Gastroenterology, University of California San Francisco, San Francisco, CA, USA

Publication History

  1. Published Online: 5 MAY 2011
  2. Published Print: 25 APR 2011

ISBN Information

Print ISBN: 9781405134897

Online ISBN: 9781444341294

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Keywords:

  • hepatitis B immune globulin;
  • prophylaxis;
  • donor;
  • peginterferon;
  • ribavirin;
  • coinfection;
  • cirrhosis;
  • retransplantation

Summary

Chronic hepatitis C (HCV) infection is one of the leading indications for liver transplantation (LT) globally. Hepatitis B virus (HBV) is a common indication for LT in Asia but accounts for less than 10% of LT in the USA and Europe. Both HBV and HCV can cause recurrent disease after LT and the course of hepatitis after LT is accelerated compared to pretransplantation. For HBV, effective prophylactic therapies, including hepatitis B immune globulin and nucleos(t)ide analogues, can prevent recurrent disease in 80% or more of cases and graft survival is excellent. For HCV, there is no effective prophylactic therapy and recurrent disease leading to graft loss occurs in up to 30% within 5°years. Consequently, survival is lower in HCV-infected LT recipients than non-HCV patients. The best strategy to extend graft survival in HCV patients is eradication of HCV infection prior to or after transplantation. Peginterferon and ribavirin, the currently approved therapy for HCV, achieves viral clearance in only 30–40% of treated LT recipients, overall, and tolerability of therapies is a major limitation. Liver transplantation is feasible for HIV-infected patients and cirrhosis secondary to HBV and HCV are the most common indications for LT in these patients. HBV–HIV coinfected LT patients have similar survival to HBV monoinfected patients, whereas survival of HCV–HIV coinfected LT patients is inferior to LT patients with HCV alone.