Present address: Dr Carla S. Coffin, University of Calgary, Calgary, AB, Canada.
Management of hepatitis B in liver transplant recipients
Article first published online: 22 OCT 2007
Journal of Viral Hepatitis
Volume 14, Issue Supplement s1, pages 37–44, November 2007
How to Cite
Coffin, C. S. and Terrault, N. A. (2007), Management of hepatitis B in liver transplant recipients. Journal of Viral Hepatitis, 14: 37–44. doi: 10.1111/j.1365-2893.2007.00916.x
- Issue published online: 22 OCT 2007
- Article first published online: 22 OCT 2007
- Received July 2007; accepted for publication August 2007
- hepatitis B immune globulin;
Summary. Advances in hepatitis B virus (HBV) antiviral prophylaxis have dramatically improved graft and patient survival for patients undergoing liver transplantation for hepatitis B related end-stage liver disease. In particular, the availability of hepatitis B immune globulin (HBIg) in combination with nucleos(t)ide analogues such as lamivudine and adefovir, have transformed outcomes. The availability of newer antivirals such as adefovir, tenofovir and entecavir either as monotherapy or in combination offer an increasing number of antiviral options. Despite these advances, significant challenges remain. Factors that affect the efficacy of anti-viral therapy include detectable HBV viraemia at the time of transplant and emergence of HBV mutants (especially in patients with prior exposure to lamivudine). HBV prophylaxis protocols are expensive especially with use of high-dose HBIg and newer nucleos(t)ide analogues. This review summarizes current HBV prophylaxis protocols and management of recurrent disease post-transplantation. There is an increasing need for individualization of therapy based on prior drug exposures, level of HBV DNA at time of transplantation and type of prophylaxis used.