8. Viral Hepatitis and Transplantation

  1. Pierre-Alain Clavien MD, PhD2 and
  2. James F. Trotter MD3
  1. Geoffrey W. McCaughan MBBS, PhD

Published Online: 28 MAR 2012

DOI: 10.1002/9781444398441.ch8

Medical Care of the Liver Transplant Patient, 4th edition

Medical Care of the Liver Transplant Patient, 4th edition

How to Cite

McCaughan, G. W. (2012) Viral Hepatitis and Transplantation, in Medical Care of the Liver Transplant Patient, 4th edition (eds P.-A. Clavien and J. F. Trotter), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444398441.ch8

Editor Information

  1. 2

    Department of Surgery, Swiss HPB (Hepato-Pancreato-Biliary) and Transplantation Center, University Hospital Zürich Zürich, Switzerland

  2. 3

    Baylor University Medical Center, Dallas, TX, USA

Author Information

  1. The AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred and the University of Sydney, The Centenary Research Institute, Sydney, NSW, Australia

Publication History

  1. Published Online: 28 MAR 2012
  2. Published Print: 10 APR 2012

ISBN Information

Print ISBN: 9781444335910

Online ISBN: 9781444398441

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Keywords:

  • hepatitis B virus;
  • hepatitis C virus;
  • hepatitis B immune globulin;
  • MELD;
  • lamivudine;
  • adefovir;
  • entecavir;
  • tenofovir;
  • drug resistance;
  • sustained virologic response

Summary

The major reasons for liver transplantation in the context of viral hepatitis is in the setting of chronic hepatitis B or chronic hepatitis C infection. In chronic HBV infection both older and new antiviral agents effectively control viral replication thus obviating the need for transplantation in many cases. It should be realized, however, there exist a group of patients who do progress despite control of viremia and transplantation should be considered in these patients earlier rather than later. In chromic HCV infection a true SVR in the pre-transplant setting has been shown to be associated with the prevention of HCV recurrence in the post-transplant setting. It should be realized however that SVR in this setting is uncommon in genotype 1 patients. In the post-transplant setting HBV recurrence can now be prevented with the use of an antiviral agent and HBIG. A post-HBIG era is approaching quickly, where HBIG is only indicated in a few patients (those who are HBV positive at transplant). In HCV recurrence the SVR rate following antiviral therapy is considerably lower than in the non-transplant setting but there is general agreement that if SVR is obtained then long-term outcomes are much improved.