title: Prophylactic managements of hepatitis B viral infection in liver transplantation.
abstract: Liver transplantation (LT) is a considerably effective treatment for patients with end-stage hepatitis B virus (HBV)-related liver disease. However, HBV infection often recurs after LT without prophylaxis. Since the 1990s, the treatment for preventing HBV reinfection after LT has greatly progressed with the introduction of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues (NAs), resulting in improved patient survival. The combination therapy consisting of high-dose HBIG and lamivudine is highly efficacious for preventing the recurrence of HBV infection after LT and became the standard prophylaxis for HBV recurrence. However, mainly due to the high cost of HBIG treatment, an alternative protocol for reducing the dose and duration of HBIG has been evaluated. Currently, combination therapy using low-dose HBIG and NAs is considered as the most efficacious and cost-effective prophylaxis for post-LT HBV reinfection. Recently, NA monotherapy and withdrawal of HBIG from combination therapy, along with the development of new, potent high genetic barrier NAs, have provided promising efficacy, especially for low-risk recipients. This review summarizes the prophylactic protocol and their efficacy including prophylaxis of de novo HBV infection from anti-HBc antibody-positive donors. In addition, challenging approaches such as discontinuation of all prophylaxis and active immunity through hepatitis B vaccination are discussed.
authors.affiliation: Takashi Onoe, Division of Applied Immunobiology, Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Hiroshima 737-0023, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Onoe
authors.affiliation: Takashi Onoe, Division of Applied Immunobiology, Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Hiroshima 737-0023, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tahara
authors.affiliation: Takashi Onoe, Division of Applied Immunobiology, Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Hiroshima 737-0023, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Takashi Onoe, Division of Applied Immunobiology, Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Hiroshima 737-0023, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D019259:Lamivudine / Q000008:administration & dosage; D016031:Liver Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000639:trends; D014019:Tissue Donors
chemical_list: D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin
keywords: Anti-hepatitis B immunoglobulin; Hepatitis B infection; Liver transplantation; Nucleos(t)ide analogue; Prophylaxis