Indications for liver transplantation for chronic viral hepatitis, and therapies for controlling hepatitis B virus infection before and after transplantation

Authors

  • Geoffrey W M C

    1. AW Morrow Gastroenterology and Liver Centre, and Australian National Liver Transplant Unit, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
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Correspondence: GeoffreyW McCaughan, AW Morrow Gastroenterology and Liver Centre, and Royal Prince Alfred Hospital and University of Sydney, Missenden Road, Camperdown, New South Wales, Australia

Abstract

The general indications for liver transplantation in hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and the issues surrounding treatment for HBV infection in the pre- and post-transplant periods, are discussed. In general, transplantation is reserved for patients with end-stage liver failure secondary to cirrhosis and a small population with acute liver failure. It is proposed that certain guidelines can be developed and that these should include any one of the following: a Child-Pugh score ≥ 9, diuretic resistant ascites, recurrent portal hypertensive bleeding, recurrent encephalopathy, spontaneous bacterial peritonitis and the development of a small hepatocellular cancer (≤ 5 cm in diameter). Treatment for HBV infection now includes lamivudine therapy pre and post transplantation together with hepatitis B immunoglobulin. Such an approach has virtually abolished recurrence of HBV infection following liver transplantation.

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