New Perspectives on Treatment of Hepatitis B Before and After Liver Transplantation

Abstract

Self financingThe hepatitis B virus (HBV) infects more than 260 million people globally, with increasing incidence, especially in developing countries. Despite antiviral therapies, HBV-related end-stage liver disease remains one of the most important indications for liver transplantation worldwide. Although new available treatments have improved the outcome of patients with both compensated and decompensated liver disease in some specific clinical settings as acute-on-chronic liver failure mortality is still high. Moreover, the incidence of HBV-related hepatocellular carcinoma (HCC) seems to be increasing and represents a major challenge for the transplant team. In the post-transplant setting, combination of anti-HBV immunoglobulins and oral nucleos(t)ides provided significant improvement on graft and patient survival. Furthermore, recent data suggested the possibility of personalized therapeutic algorithms based on pre and post-transplant viral and host risk factors. Finally, liver grafts from HBV core antibody (anti-HBc) positive or hepatitis B surface antigen (HBsAg) donors can be safely used in order to expand the donor pool, considering adequate allocation and tailored prophylaxis after LT. In this review we have focused on the evolution of antiviral therapy for HBV, highlighting useful information to aid the transplant hepatologist in clinical practice.

Liver Diseases and the Hemostasis (Rewiew) Part 1. Non-Cholestatic Diseases of the Liver and Hemostasis

“…Orthotopic liver transplantation is the only cure for a wide range of end-stage liver diseases, such as liver cirrhosis of viral etiology, liver cirrhosis of alcoholic etiology, primary biliary cholangitis, primary sclerosing cholangitis, fulminant liver failure, malignant liver tumors, Badd-Chiari syndrome and a number of diseases manifested by metabolic disorders of the liver [42][43][44][45][46][47][48][49].…”

“…Ортотопическая трансплантация печени является единственным эффективным способом лечения в терминальной стадии заболеваний печени, таких как: цирроз печени вирусной и алкогольной этиологии, первичный билиарный холангит, первичный склерозирующий холангит, фульминантная печеночная недостаточность, злокачественные опухоли печени, синдром Бадд-Киари и ряд заболеваний, проявляющихся метаболическими нарушениями на уровне печени [42][43][44][45][46][47][48][49].…”