Liver transplantation for viral hepatitis in 2015

Abstract

Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and for patients with liver cell cancer related to liver disease. Acute and chronic liver diseases related to hepatitis viruses are between the main indications for liver transplantation. The risk of viral reinfection after transplantation is the main limiting factor in these indications. Before the availability of antiviral prophylaxis, hepatitis B virus (HBV) recurrence was universal in patients who were HBV DNA-positive before transplantation. The natural history of recurrent HBV was accelerated by immunosuppression, and it progressed rapidly to graft failure and death. Introduction of post-transplant prophylaxis with immunoglobulin alone first, and associated to antiviral drugs later, drastically reduced HBV recurrence, resulting in excellent long-term outcomes. On the contrary, recurrence of hepatitis C is the main cause of graft loss in most transplant programs. Overall, patient and graft survival after LT for hepatitis C virus (HCV)-associated cirrhosis is inferior compared with other indications. However, successful pretransplant or post transplant antiviral therapy has been associated with increased graft and overall survival. Until recently, the combination of pegylated interferon and ribavirin was the standard of care for the treatment of patients with chronic hepatitis C. Highly active antiviral compounds have been developed over the past decade, thanks to new in vitro systems to study HCV entry, replication, assembly, and release.

Usefulness of albumin‐bilirubin grade for evaluation of long‐term prognosis for hepatitis B‐related cirrhosis

“…Liver transplantation remains the only therapeutic option but not available for most HBV‐associated cirrhotic patients due to the expensive charge, shortage of donor and serious post‐transplantation complications . The 1‐year mortality of liver cirrhosis differs dramatically from 1% to 57% depending on the occurrence of complications, and the majority of patients with cirrhosis are asymptomatic.…”

The Role of Humoral Alloreactivity in Liver Transplantation: Lessons Learned and New Perspectives

“…IR injury can be minimized by appropriate donor selection and minimization of ischemia times, and a great deal of research efforts have been dedicated to identifying strategies that attenuate IR injury following transplantation. Impressive advances have been made in the treatment of hepatitis B and hepatitis C virus infections over the past few decades, and sustained viral responses can be consistently achieved to prevent viral reinfection after LT [50]. …”

Recent advances in understanding and managing liver transplantation

“…Although HCV is currently the leading etiology among adult LT recipients 24 , in 2012 non-alcoholic steatohepatitis (NASH) was the etiology with the most rapid rise in frequency, increasing 4-fold from 2002 to 2012 25 . Other main indications for LT are alcoholic liver disease, HBV-related cirrhosis, primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC), and autoimmune hepatitis (AIH).…”