Liver transplantation in chronic hepatitis B and C.
The general indications for liver transplantation in hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and the issues surrounding treatment for HBV infection in the pre- and post-transplant periods, are discussed. In general, transplantation is reserved for patients with end-stage liver failure secondary to cirrhosis and a small population with acute liver failure. It is proposed that certain guidelines can be developed and that these should include any one of the following: a Child-Pugh score > or = 9, diuretic resistant ascites, recurrent portal hypertensive bleeding, recurrent encephalopathy, spontaneous bacterial peritonitis and the development of a small hepatocellular cancer (< or = 5 cm in diameter). Treatment for HBV infection now includes lamivudine therapy pre and post transplantation together with hepatitis B immunoglobulin. Such an approach has virtually abolished recurrence of HBV infection following liver transplantation.
McCaughan
G W
GW
AW Morrow Gastroenterology and Liver Centre, and Australian National Liver Transplant Unit, Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales.
D000998:Antiviral Agents / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D012008:Recurrence
D000998:Antiviral Agents