Prevention of recurrent hepatitis B post–liver transplantation

Authors

  • Anna S.F. Lok MD

    Corresponding author
    1. From the University of Michigan, Ann Arbor, MI
    • Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI 48109-0362. Telephone: 734-615-4628; FAX: 734-936-7392
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Abstract

  • 1Factors associated with a lower rate of recurrent hepatitis B post–liver transplantation (LT) are negative hepatitis B e antigen and/or serum hepatitis B virus DNA pre-LT, hepatitis D virus superinfection, and fulminant hepatitis B.
  • 2Long-term intravenous hepatitis B immune globulin (HBIG) monotherapy can reduce the overall rate of recurrent hepatitis B to 20% to 35%.
  • 3Long-term lamivudine monotherapy is associated with a risk for drug resistance and overall 3-year rate of recurrent hepatitis B of 40% to 50%.
  • 4Combination prophylaxis with HBIG and lamivudine can reduce the overall rate of recurrent hepatitis B to 0% to 10%.
  • 5The dose and duration of HBIG therapy needed when used in combination with lamivudine may be lower, but the optimal regimen remains to be determined.
  • 6Lamivudine resistance before LT is associated with an increased risk for recurrent hepatitis B post-LT.
  • 7A cost-effective prophylactic regimen to prevent recurrent hepatitis B should be tailored according to risk.

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