The prevention of viral recurrence in the long term

https://doi.org/10.1016/S1590-8658(09)60444-8Get rights and content

Abstract

The transplantation outcome depends largely on the prevention of hepatitis B recurrence. The spontaneous risk of HBV reinfection exceeds 75%, but major advances in prophylaxis during the last 15 years have led to the control of post-transplant hepatitis B reinfection in more than 90% of HBV transplants. Treatment with hepatitis B immune globulins (HBIG) plays a major role in prophylaxis, either as monotherapy in non-replicating patients or in combination with antiviral drugs in replicating subjects. Although no standardized therapeutic protocols have been defined, at present the prevailing approach is to use high-dose intravenous HBIG in the immediate perioperative period (first week, induction phase) and to administer over the long term monthly fixed or on-demand doses of intravenous or intramuscular HBIG (maintenance therapy), in association with antiviral(s). Results have been excellent, yet different strategies of long-term prophylaxis have been proposed in order to simplify therapy and reduce costs. Long-term prophylaxis with antiviral(s) and low-dose intramuscular HBIG seems to be the most promising option; in stable patients, the combination with antiviral agents reduces the need of HBIG, in particular when using on-demand administration protocols and intramuscular HBIG has proven as effective and safe as intravenous preparations during the maintenance phase.

References (19)

There are more references available in the full text version of this article.

Cited by (14)

  • Common issues in the management of patients in the waiting list and after liver transplantation

    2017, Digestive and Liver Disease
    Citation Excerpt :

    Risk factors associated with high rates of HBV reactivation are a high viral load prior to the transplant, HBeAg positivity, HIV co-infection, non-compliance, HCC at the time of the transplant, and drug resistance [41,42]. Hepatitis B immunoglobulins (HBIG) have been the core component of HBV prophylaxis since the landmark study by Samuel et al. in 1991, who showed that HBV recurrence could be prevented by the long-term administration of HBIG in 80% of non-viremic transplant patients [43,44]. When the first oral antiviral drug against HBV (Lamivudine) became available, antiviral monotherapy was attempted as an alternative, but failed to maintain results on a par with those achieved by HBIG in terms of HBV recurrence.

  • Management of HBV resistance in the post-transplant setting

    2011, Digestive and Liver Disease Supplements
  • Does pre-liver transplant HBV DNA level affect HBV recurrence or survival in liver transplant recipients receiving HBIG and Nucleoside Analogues?

    2011, Annals of Hepatology
    Citation Excerpt :

    The only patient in our cohort with an HBV-DNA level ≥ 105 IU/mL who received HBIg and LAM did not experience HBV recurrence. This contrasts with results from earlier reports1,34,35 but is similar those described in recent studies.24,28,29,36 Hence, the presence of viral replication should not be considered an absolute contraindication for liver transplantation if an adequate postoperative prophylaxis is used.28,29

View all citing articles on Scopus
View full text