RESEARCH ARTICLE


A Review of Hepatitis B Management in Pre- and Post-Liver Transplant Recipients



Sandeep Mukherjee*
Section of Gastroenterology and Hepatology, 983285 Nebraska Medical Center, Omaha, NE 68198-3285, USA.


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© 2010 Sandeep Mukherjee.;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Section of Gastroenterology and Hepatology, 983285 Nebraska Medical Center, Omaha, NE 68198-3285, USA; Tel: 402-559-8859; Fax: 402-559-3434; E-mail: smukherj@unmc.edu


Abstract

Liver transplantation was approved for treatment of decompensated cirrhosis in the United States in 1983. Hepatitis B and hepatitis C viruses are the leading causes of liver transplantation for viral hepatitis and hepatitis B is also an important cause of liver transplantation for called acute liver failure) due to either acute hepatitis B or an acute exacerbation of chronic hepatitis B. However, until the introduction of hepatitis B immunoglobulin and nucleoside/nucleotide analogues nearly twenty years ago, liver transplantation for hepatitis B was characterized by universal recurrence with a dismal prognosis. The widespread use of oral anti-virals in the US has led to a decreased incidence of decompensated liver disease and patients waitlisted for liver transplantation. Among patients listed for hepatocellular carcinoma, the decrease in waitlist registration was also least dramatic among patients with HBV, possibly related to the use of oral antivirals. At present, liver transplantation for hepatitis B, regardless of whether for decompensated cirrhosis, hepatocellular carcinoma satisfying Milan criteria or acute liver failure has excellent outcomes with results comparable if not better to other liver transplant recipients. This article will review the management of patients with decompensated cirrhosis from HBV prior to liver transplantation, the use of hepatitis B positive donors and the prevention and management of hepatitis B after liver transplantation.

Keywords: Hepatitis B, Nucleos(t)ide, Decompensated Cirrhosis, Liver Transplantation, Prophylaxis, Hepatitis B Immune Globulins.