The prevention of viral recurrence in the long term.
The transplantation outcome depends largely on the prevention of hepatitis B recurrence. The spontaneous risk of HBV reinfection exceeds 75%, but major advances in prophylaxis during the last 15 years have led to the control of post-transplant hepatitis B reinfection in more than 90% of HBV transplants. Treatment with hepatitis B immune globulins (HBIG) plays a major role in prophylaxis, either as monotherapy in non-replicating patients or in combination with antiviral drugs in replicating subjects. Although no standardized therapeutic protocols have been defined, at present the prevailing approach is to use high-dose intravenous HBIG in the immediate perioperative period (first week, induction phase) and to administer over the long term monthly fixed or on-demand doses of intravenous or intramuscular HBIG (maintenance therapy), in association with antiviral(s). Results have been excellent, yet different strategies of long-term prophylaxis have been proposed in order to simplify therapy and reduce costs. Long-term prophylaxis with antiviral(s) and low-dose intramuscular HBIG seems to be the most promising option; in stable patients, the combination with antiviral agents reduces the need of HBIG, in particular when using on-demand administration protocols and intramuscular HBIG has proven as effective and safe as intravenous preparations during the maintenance phase.
Marzano
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Gastroenterology and Hepatology Unit, San Giovanni Battista Hospital, Turin, Italy. alfredomarzano@yahoo.it
D000998:Antiviral Agents / Q000008:administration & dosage; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D016031:Liver Transplantation; D019990:Perioperative Care / Q000191:economics / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000517:prevention & control*; D055502:Secondary Prevention; D016896:Treatment Outcome
D000998:Antiviral Agents; D007136:Immunoglobulins; C045213:hepatitis B hyperimmune globulin