title: Prevention of hepatitis B virus reinfection in liver transplant recipients.
abstract: Antiviral therapy using newer nucleos(t)ide analogues with lower resistance rates such as entecavir or tenofovir could suppress hepatitis B virus (HBV) replication, improve liver function, delay or obviate the need for liver transplantation in some patients, and reduce the risk of HBV recurrence. The combination of long-term antiviral and low-dose hepatitis B immune globulin (HBIG) can effectively prevent HBV recurrence in more than 90% of transplant recipients. Some form of HBV prophylaxis needs be continued indefinitely after transplantation. However, in patients with a low risk of HBV recurrence (i.e. HBV DNA levels undetectable before transplantation), it is possible to discontinue HBIG and maintain long-term antiviral therapy. A more cautious approach to prophylaxis regimen is necessary for those patients with high pretransplant HBV DNA levels, those with limited antiviral options if HBV recurrence occurs (i.e. HIV or HDV coinfection, preexisting drug resistance), those with a high risk of hepatocellular carcinoma recurrence, and those with a risk of noncompliance to antiviral therapy.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Roche
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D063065:Organophosphonates / Q000627:therapeutic use; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D000068698:Tenofovir; D066027:Transplant Recipients; D014779:Virus Replication / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir; D000225:Adenine; C045213:hepatitis B hyperimmune globulin