Hepatitis B in liver transplant recipients



Key Concepts:

  • 1The use of low-dose immunosuppressive therapy along with pre- and posttransplantation nucleos(t)ide therapy and posttransplantation hepatitis B immunoglobulin (HBIG) has yielded marked improvements in survival.
  • 2Lamivudine (Epivir-HBV), adefovir (Hepsera), entecavir (Baraclude), tenofovir (Viread), emtricitabine (Emtriva), and the combination drugs tenofovir + emtricitabine (Truvada) and abacavir + lamivudine (Epzicom) are effective nucleos(t)ide antiviral agents that, in some cases, may help reverse liver disease sufficiently to avoid transplant.
  • 3In posttransplantation patients, virus suppression with some combination of HBIG and the nucleos(t)ide agents may prevent graft loss and death or the need for a second transplant.
  • 4In both the pre- and posttransplantation setting, the goal of hepatitis B virus management is complete virus suppression.
  • 5The use of low-dose intramuscular HBIG is evolving, with studies showing that dosing and cost can be reduced by 50–300% with a customized approach.
  • 6Elimination of HBIG from the treatment paradigm is currently under evaluation and may be possible with the use of newer medications that have no or low resistance rates.
  • 7Although there is growing evidence that some types of combination therapy may decrease the chance that drug resistance will develop and increase the likelihood of long-term success in preventing graft loss and death, additional research will be required to determine which combinations will work well in the long term, and which will not. Liver Transpl 12:S54–S64, 2006. © 2006 AASLD.