[Current concepts for prophylaxis and treatment of hepatitis B virus reinfection after liver transplantation].
Pretransplant complete viral suppression and posttransplant combined hepatitis B immunglobulin (HBIG)/nucleos(t)ide analog therapy lead to successful prevention of hepatitis B virus (HBV) reinfection in approximately 95% of HBV patients. Low-dose intramuscular HBIG protocols have yielded cost reduction by > 50%. However, passive immunoprophylaxis is still expensive and requires close monitoring of the liver transplant (LT) patient. HBIG-free therapeutic regimens with new promising nucleos(t)ide analog combinations are currently being investigated for their efficacy and safety as first-line therapy in clinical studies.Third-generation HBV vaccines, including the S, pre-S1, and pre-S2 regions or combination vaccines with immunostimulatory adjuvants, seem to be more immunogenic than the currently available vaccines and may allow long-term discontinuation of HBIG in selected responders. Adoptive transfer of immunity against HBV was successful in some LT patients in clinical studies. Future investigations need to elucidate, if donor-derived immunity is a transient immunologic phenomenon or persistently controls HBV.
Beckebaum
Susanne
S
Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen. susanne.beckebaum@uni-due.de
Cicinnati
Vito R
VR
Gerken
Guido
G
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000517:prevention & control* / Q000628:therapy / Q000821:virology; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D016031:Liver Transplantation; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013997:Time Factors
D000276:Adjuvants, Immunologic; D000998:Antiviral Agents; D004279:DNA, Viral; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin