title: Review of the pharmacological management of hepatitis B viral infection before and after liver transplantation.
abstract: The progress in treatment against hepatitis B virus (HBV) with the development of effective and well tolerated nucleotide analogues (NAs) has improved the outcome of patients with HBV decompensated cirrhosis and has prevented post-transplant HBV recurrence. This review summarizes updated issues related to the management of patients with HBV infection before and after liver transplantation (LT). A literature search using the PubMed/Medline databases and consensus documents was performed. Pre-transplant therapy has been initially based on lamivudine, but entecavir and tenofovir represent the currently recommended first-line NAs for the treatment of patients with HBV decompensated cirrhosis. After LT, the combination of HBV immunoglobulin (HBIG) and NA is considered as the standard of care for prophylaxis against HBV recurrence. The combination of HBIG and lamivudine is related to higher rates of HBV recurrence, compared to the HBIG and entecavir or tenofovir combination. In HBIG-free prophylactic regimens, entecavir and tenofovir should be the first-line options. The choice of treatment for HBV recurrence depends on prior prophylactic therapy, but entecavir and tenofovir seem to be the most attractive options. Finally, liver grafts from hepatitis B core antibody (anti-HBc) positive donors can be safely used in hepatitis B surface antigen negative, preferentially anti-HBc/anti-hepatitis B surface antibody positive recipients.
authors.affiliation: Evangelos Cholongitas, the 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Cholongitas
authors.affiliation: Evangelos Cholongitas, the 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: George V
authors.initials: GV
authors.lastname: Papatheodoridis
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents
keywords: Adefovir; Antivirals; Entecavir; Hepatitis B virus; Hepatitis B virus immunoglobulin; Lamivudine; Liver transplantation; Resistance; Telbivudine; Tenofovir