Trends in the Management of Hepatitis B Virus Infection after Liver Transplantation

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Report (EN)

2007 (EN)
Trends in the Management of Hepatitis B Virus Infection after Liver Transplantation (EN)

V. Sevastianos, A.K. Burroughs, G.V. Papatheodoridis,

SUMMARY Post-transplant hepatitis B virus (HBV) recurrence occurs in the majority of patients transplanted for HBV liver disease, if left untreated. Post-transplant prophylaxis with hepatitis B immune globulin (HBIG) has significantly reduced HBV recurrence rates, but it is rather ineffective in patients with chronic liver disease and pre-transplant detectable serum HBV-DNA by hybridization assays. Moreover, long-term HBIG administration increases the cost of post-transplant medical therapy and may be associated with emergence of escape HBV mutants. Lamivudine is the first antiviral agent to be widely used in the management of HBV transplant patients. Pre-transplant lamivudine therapy lowers HBV viremia, decreasing the risk of post-transplant HBV recurrence, but to try and minimize virologic breakthroughs due to resistant HBV strains, it should be started within the prior to 6 months the anticipated timing of transplantation, which is often difficult in practice. Prophylactic post-transplant lamivudine monotherapy is associated with progressively increasing HBV recurrence rates, but combined therapy with lamivudine and HBIG at relatively low dosage is currently the most effective approach in this setting, even in HBV-DNA positive patients, who also receive lamivudine in the pre-transplant period. The most frequent therapy for post-transplant HBV recurrence is lami- vudine, but the increasing resistance rates represent a challenging problem. Adefovir dipivoxil is currently the most promising agent amongst those tried for lamivudine resistant HBV strains. All these advances in anti-HBV therapy have made HBV liver disease an indication for liver transplantation, irrespective of viral replication status, a complete turn around from 10 years ago. Key words: hepatitis B virus, liver transplantation, hepatitis B immune globulin, nucleoside analogues, lamivudine, adefovir, entecavir, viral resistance, YMDD mutants (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 16, No 2 (2003) (EN)

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