Liver transplantation for hepatitis B virus. Pre-emptive and peri-operative prophylaxis.
In the past, reinfection of the graft by hepatitis B virus (HBV) after liver transplantation for HBV-related liver disease was often followed by severe liver damage and reduced survival. The long-term administration of hepatitis B immunoglobulin (HBIG) dramatically reduced this risk. However, this procedure was ineffective in most patients with active viral replication pre-transplant. The use of lamivudine in the pre-transplant setting partially solved this problem. The emergence of resistant mutants to lamivudine was also solved by the addition of adefovir. At present, combination therapy by oral antivirals pre-transplant and HBIG plus the same drugs post-transplant achieves nearly 100% of protection against graft reinfection. In a recent study, a new intravenous HBIG, Niuliva has shown high efficacy in achieving protective anti-HBs levels after liver transplantation for HBV-related liver diseases, as well as a good safety profile. Using combination therapies, the doses of HBIG can be reduced or even stopped after several weeks or months post-transplant, continuing with oral antivirals alone. The recently introduced antivirals achieve a very high antiviral potency and low risk of resistance. This may further increase the efficacy in preventing graft reinfection in the post-liver transplantation setting.
Mas
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ICU for Digestive & Metabolic Diseases, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain. amas@clinic.ub.es
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000998:Antiviral Agents / Q000008:administration & dosage; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000517:prevention & control* / Q000601:surgery* / Q000821:virology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D019259:Lamivudine / Q000008:administration & dosage; D016031:Liver Transplantation; D063065:Organophosphonates / Q000008:administration & dosage; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control* / Q000821:virology; D055502:Secondary Prevention; D016896:Treatment Outcome
D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins; D063065:Organophosphonates; D019259:Lamivudine; C053001:adefovir; D000225:Adenine; C045213:hepatitis B hyperimmune globulin