Posttransplantation prevention and treatment of recurrent hepatitis B

Rizzetto, M.; Marzano, Alfredo

doi:10.1053/jlts.2000.19058

Cited by 13 publications

(3 citation statements)

References 25 publications

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“…Other studies identified the protective role played by HDV in prevention of HBV recurrence after LT, because HDV exerts a suppressive effect on HBV replication after LT. Regarding HBVrelated ALF, the second group at lower risk of HBV recurrence, some authors asserted that the acute and massive necrosis secondary to fulminant infection can led to a natural clearance of the viral load [82,83].…”

Section: Recurrence Of Hbv Infection After Ltmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Recurrence Of Hbv Infection After Ltmentioning

confidence: 99%

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

et al. 2016

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“…Viral eradication is rare with any currently approved medication, including interferon, foscarnet, ganciclovir, famciclovir, and lamivudine. 40,[69][70][71][72][73][74] Lamivudine is by far the most effective agent to reduce HBV DNA levels. Perrillo et al 40 reported on 52 patients, all with recurrent HBV after OLT and 60% of whom had undetectable HBV DNA at the end of treatment, with HBeAg seroconversion in 31% and a YMDD mutation rate of 27% in the cohort.…”

Section: Treatment Of Recurrent or De Novo Hepatitis B In Liver Transmentioning

confidence: 99%

A concise update on the status of liver transplantation for hepatitis B virus: The challenges in 2002

Vargas

Dodson

Rakela

2002

Liver Transplantation

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Historical PerspectiveI n the early 1970s, results of OLT for chronic HBV infection were hampered by recurrent infection with the host HBV strain and subsequent allograft failure caused by recurrent hepatitis. 1-4 Even in these very early days of hepatic transplantation, distinct patterns of hepatic injury were noted. 4,5 Specifically, chronic lobular hepatitis similar to pre-OLT HBV was described in a large proportion of patients with recurrence. Ten percent to 30% of patients developed the newly named fibrosing cholestatic hepatitis, characterized histologically by thin perisinusoidal bands of fibrosis extending from portal tracts to surround plates of ductular-type epithelium; prominent cholestasis, ground-glass transformation, and ballooning of hepatocytes with cell loss; and mild mixed inflammatory reaction. 6 The clinical behavior of fibrosing cholestatic hepatitis reflected rapid graft dysfunction and progression to cirrhosis. 7 In the next decade, prophylaxis was attempted unsuccessfully with low-dose hepatitis B immune globulin (HBIG) administered for less than 3 months after OLT. 8,9 The Hanover group subsequently adjusted HBIG dosages to maintain the hepatitis B surface antigen (HbsAg) antibody (anti-HBs) titer at greater than 100 IU/L for a minimum of 6 months after OLT. 10

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“…20 Because the YMDD mutant replicates inefficiently compared with wild-type HBV, the relatively small number of virions may be unlikely to escape HBIG binding. The use of combination lamivudine and HBIG (high or low dose) has been reported in more than 135 patients treated worldwide, 21 with recurrence rates consistently less than 10%. In a study from the University of California at Los Angeles, 22 13 patients were treated prophylactically with lamivudine and high-dose HBIG (starting with 10,000 IU during the anhepatic phase).…”

Section: Preemptive Treatment With Nucleoside Analogues Alone or In Cmentioning

confidence: 99%

Hepatitis B and C in the liver transplant recipient: Current understanding and treatment

Rosen

2001

Liver Transplantation

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L iver disease related to chronic viral hepatitis, i.e., hepatitis B and C, is a leading indication for orthotopic liver transplantation (OLT) worldwide. Viral reinfection of the liver allograft may lead to graft failure, death, or the need for re-OLT. The evolution of our understanding and management of hepatitis B (HBV) and hepatitis C virus (HCV) infection in liver transplant recipients has been extraordinarily rapid in the last decade. The focus of this review is recent developments in our understanding of viral hepatitis, including the natural history, mechanisms of recurrence, and treatment. Overview of HBV Infection in Liver Transplant RecipientsWithout antiviral prophylaxis, OLT in patients with HBV infection commonly results in reinfection that compromises the viability of the allograft and negatively influences survival. 1 Many centers became reluctant to offer OLT to HBV-infected patients, and the number of transplantations performed in the United States for this indication declined through the early 1990s. 2 After the protective effect of high-dose hepatitis B immunoglobulin (HBIG) and prognostic significance of active HBV replication pre-OLT were recognized, strategies to help prevent graft reinfection by HBV evolved. More recently, nucleoside analogues, either alone or in conjunction with HBIG, are being used to prevent viral recurrence. Current concerns include the prevention of mutant forms of HBV described with monotherapy with either nucleoside analogues 3 or HBIG, 4,5 as well as providing adequate allograft protection against recurrent HBV infection without the prohibitively high cost of high-dose HBIG. The management of HBV infection in an OLT candidate has undergone a significant change over the last decade, and it is now possible to offer OLT with a low likelihood of serious graft reinfection for a candidate with HBV infection. Prophylaxis With HBIGBased on a landmark multicenter European study of more than 300 patients, three key determinants of HBV reinfection were identified: HBIG prophylaxis, HBV replicative status pre-OLT, and type of liver disease. 6 The greatest risk for recurrence, an 83% actuarial rate at 3 years, was observed in transplant recipients who had markers of active replication, i.e., hepatitis B e antigen (HBeAg) in serum and HBV DNA detectable by molecular hybridization pre-OLT. The lowest HBV recurrence rate (16%) was in patients who underwent OLT for severe acute HBV infection leading to liver failure, in which paradoxically spontaneous clearance of HBV is frequent. Patients with chronic HBV without markers of active replication had an intermediate rate of HBV recurrence at 58%. Coinfection with hepatitis delta virus resulted in a lower rate of HBV recurrence at 32%. By multivariate analysis, administration of highdose HBIG for more than 6 months post-OLT, as well as hepatitis delta virus coinfection and acute rather than chronic HBV infection, were significant predictors of

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Posttransplantation prevention and treatment of recurrent hepatitis B

Cited by 13 publications

References 25 publications

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

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

A concise update on the status of liver transplantation for hepatitis B virus: The challenges in 2002

Hepatitis B and C in the liver transplant recipient: Current understanding and treatment

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