Current prophylactic strategies against hepatitis B virus recurrence after liver transplantation.
Prophylactic strategies against hepatitis B virus (HBV) recurrence after liver transplantation (LT) are essential for patients with HBV-related disease. Before LT, lamivudine (LAM) was proposed to be down-graded from first- to second-line therapy. In contrast, adefovir dipivoxil (ADV) has been approved not only as first-line therapy but also as rescue therapy for patients with LAM resistance. Furthermore, combination of ADV and LAM may result in lower risk of ADV resistance than ADV monotherapy. Other new drugs such as entecavir, telbivudine and tenofovir, are probably candidates for the treatment of hepatitis-B-surface-antigen-positive patients awaiting LT. After LT, low-dose intramuscular hepatitis B immunoglobulin (HBIG), in combination with LAM, has been regarded as the most cost-effective regimen for the prevention of post-transplant HBV recurrence in recipients without pretransplant LAM resistance and rapidly accepted in many transplant centers. With the introduction of new antiviral drugs, new hepatitis B vaccine and its new adjuvants, post-transplant HBIG-free therapeutic regimens with new oral antiviral drug combinations or active HBV vaccination combined with adjuvants will be promising, particularly in those patients with low risk of HBV recurrence.
Jiang
Li
L
Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Jiang
Li-Sheng
LS
Cheng
Nan-Sheng
NS
Yan
Lu-Nan
LN
D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D055502:Secondary Prevention
D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D007372:Interferons