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Evolving strategies to prevent HBV recurrence
Article first published online: 20 SEP 2004
Copyright © 2004 American Association for the Study of Liver Diseases
Supplement: Summary Report of a National Conference: Evolving Concepts in Liver Allocation in the MELD and PELD Era From the October 29, 2004 AASLD/ILTS Transplant Course
Volume 10, Issue Supplement 10S, pages S74–S85, October 2004
How to Cite
Roche, B. and Samuel, D. (2004), Evolving strategies to prevent HBV recurrence. Liver Transpl, 10: S74–S85. doi: 10.1002/lt.20258
- Issue published online: 21 SEP 2004
- Article first published online: 20 SEP 2004
- 1Long-term prophylaxis with hepatitis B immune globulin (HBIG) significantly reduces the risk for hepatitis B virus (HBV) recurrence and increases survival. Patients with HBV cirrhosis and / or positive HBV DNA at the time of transplantation have a high risk for recurrence despite HBIG prophylaxis.
- 2Pre–orthotopic liver transplantation (OLT) antiviral treatment using lamivudine (LAM) can suppress HBV replication before transplantation and may induce clinical improvement in a subset of patients. Adefovir dipivoxil (ADV) may serve as “rescue” therapy for patients with LAM resistance; its place as first-line therapy requires further evaluation.
- 3Combination prophylaxis with LAM and HBIG prevents HBV recurrence in 90% to 100% of patients who undergo transplantation for hepatitis B. The optimal HBIG protocol in the “nucleoside-nucleotide analog era” remains to be determined. The place of ADV or LAM as first-line posttransplant antiviral therapy in combination with HBIG requires further studies.
- 4Future research should test new protocols using lower HBIG doses given intravenously (IV) or intramuscularly (IM) alone or in combination with antiviral agents and identify patients in whom HBIG prophylaxis can be stopped safely or replaced by antiviral agents or vaccination. (Liver Transpl 2004;10:S74–S85.)