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Semin Liver Dis 2004; 24: 55-62
DOI: 10.1055/s-2004-828679
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Management of Hepatitis B in Liver Transplantation Patients

Didier Samuel1
  • 1Centre Hépatobiliaire, Université Paris-Sud, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris, Villejuif, France
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Publication History

Publication Date:
11 June 2004 (online)

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The success of orthotopic liver transplantation for patients with hepatitis B virus (HBV) disease has been compromised by reinfection. Prophylaxis has dramatically lowered the rate of reinfection and increased patient survival. Long-term treatment with hepatitis B immunoglobulin (HBIg), although expensive, is effective. New antiviral nucleoside analogs have also been evaluated. In patients with cirrhosis and replicative HBV infection, lamivudine before transplantation and in combination with HBIg post transplantation reduces reinfection, but the rate of resistance mutation is rather high, reaching 25% at 2 years. Adefovir has been used as a rescue therapy and prior to transplantation in lamivudine-resistant patients, significantly improving liver function and reducing HBV DNA levels. Patients with active viral replication should receive preoperative antiviral therapy with lamivudine. HBIg therapy may be discontinued in selected patients after transplantation, albeit with caution, because low levels of HBV DNA have persisted. Antiviral therapy has improved the prognosis after graft infection.

KEYWORDS

Orthotopic liver transplantation - reinfection - antiviral therapy - resistance mutation

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 Dr.
Didier Samuel

Centre Hépatobiliaire, EA 3541 et association Claude Bernard “virus et transplantation,” Université Paris-Sud, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris

14 avenue Paul Vaillant Couturier

94800, Villejuif, France

Email: didier.samuel@pbr.ap-hop-paris.fr