Molecular Mechanisms to Control Post-Transplantation Hepatitis B Recurrence.
Hepatitis B often progresses to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT). Although newer nucleos(t)ide analogues result in >90% viral and hepatitis activity control, severely decompensated patients still need OLT because of drug-resistant virus, acute exacerbation, or hepatocellular carcinoma. Acute hepatitis B is also an indication for OLT, because it can progress to fatal acute liver failure. After OLT, the hepatitis B recurrence rate is >80% without prevention, while >90% of transplant recipients are clinically controlled with combined hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogue treatment. However, long-term HBIG administration is associated with several unresolved issues, including limited availability and extremely high cost; therefore, several treatment protocols with low-dose HBIG, combined with nucleos(t)ide analogues, have been investigated. Another approach is to induce self-producing anti-hepatitis B virus (HBV) antibodies using an HBV envelope (HBs) antigen vaccine. Patients who are not HBV carriers, such as those with acutely infected liver failure, are good candidates for vaccination. For chronic HBV carrier liver cirrhosis patients, a successful vaccine response can only be achieved in selected patients, such as those treated with experimentally reduced immunosuppression protocols. The present protocol for post-OLT HBV control and the future prospects of newer treatment strategies are reviewed.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. akitaka@md.okayama-u.ac.jp.
Akinobu
A
Takaki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. yasuna-t@cc.okayama-u.ac.jp.
Tetsuya
T
Yasunaka
Department of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. liver@cc.okayama-u.ac.jp.
Takahito
T
Yagi
D000225:Adenine / Q000276:immunology / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000276:immunology / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000276:immunology / Q000628:therapy* / Q000821:virology; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000276:immunology / Q000628:therapy* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects
D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D000225:Adenine; C045213:hepatitis B hyperimmune globulin
acute hepatitis B; hepatitis B immunoglobulin; hepatitis B virus vaccine; liver cirrhosis; liver transplantation; nucleos(t)ide analogue