Hepatitis B virus infection and liver transplantation.

Terrault, Norah A.; Wright, T L

doi:10.1136/gut.40.5.568

Cited by 31 publications

(16 citation statements)

References 39 publications

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“…The 3-year actuarial survival of 587 patients with HBV who underwent OLT in the United States (US) from 1987 to 1991 was only 55%, compared with 68% to 78% in patients undergoing OLT for other forms of liver disease. Similar results were reported from another US multicenter study, with a 5-year survival rate of 50% in patients transplanted for decompensated HBV without immunoprophylaxis [2].…”

Section: Recurrent Hepatitis Bsupporting

confidence: 87%

Treatment of hepatitis B and C following liver transplantation

Sponseller¹,

Ramrakhiani²

2003

Curr hepatitis rep

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Section: Recurrent Hepatitis Bsupporting

confidence: 87%

Treatment of hepatitis B and C following liver transplantation

Sponseller¹,

Ramrakhiani²

2003

Curr hepatitis rep

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“…1-2 The introduction of the long-term use of anti-HBs immune globulins (HBIg) has allowed the reduction of graft reinfection to acceptable levels, resulting in survival rates comparable with, or even better than, those of other indications. [3][4][5] This passive immunoprophylaxis strategy is therefore currently considered the standard treatment to prevent HBV reinfection after liver transplantation for HBV-related cirrhosis. 6 Yet, using this approach, posttransplant HBV recurrence still occurs in 10% to 30% of cases, possibly depending on a variety of factors, such as the amount of HBIg infused, the route and frequency of administration, and the minimum trough levels of anti-HBs maintained during various periods after transplant.…”

mentioning

confidence: 99%

Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis

et al. 2002

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Long-term immunoprophylaxis with anti-HBs immunoglobulins (HBIgH BV reinfection after liver transplantation for HBVrelated cirrhosis is frequent in the absence of immunoprophylaxis and is associated with poor prognosis, resulting from the development of cirrhosis, fibrosing hepatitis, or fulminant hepatitis. 1-2 The introduction of the long-term use of anti-HBs immune globulins (HBIg) has allowed the reduction of graft reinfection to acceptable levels, resulting in survival rates comparable with, or even better than, those of other indications. [3][4][5] This passive immunoprophylaxis strategy is therefore currently considered the standard treatment to prevent HBV reinfection after liver transplantation for HBV-related cirrhosis. 6 Yet, using this approach, posttransplant HBV recurrence still occurs in 10% to 30% of cases, possibly depending on a variety of factors, such as the amount of HBIg infused, the route and frequency of administration, and the minimum trough levels of anti-HBs maintained during various periods after transplant. 6 According to current recommendations, HBIg should be administered indefinitely after transplant. This is associated with a number of problems, including the limited availability of HBIg, the possible emergence of HBV envelope protein mutations, 7,8 and/or other adverse events, 9,10 and, most importantly, the extremely high costs. 6 Whatever is the prophylactic regimen used (which varies remarkably from one Center to another) and the cost differences of HBIg preparations between U.S. and most Western European countries, the expenses of post-transplant HBIg administration range between $25,000 and $120,000 per year, thus exceeding in a few years those of an uncomplicated transplant.New prophylactic strategies to prevent posttransplant HBV recurrence are therefore needed. New approaches under evaluation include the combination of lower doses of HBIg with antivirals, such as lamivudine, 11,12 and HBV vaccination, as proposed in the recent provocative study of Sanchez-Fueyo et al. 13 from Spain.

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“…This section will deal only with pretransplant issues. There is much evidence to suggest that active viral replication in the recipient at the time of transplantation predisposes the transplant recipient to later development or recurrence of clinically evident HBV or HCV [54]. In particular, a positive HBV-DNA test result at the time of transplantation is a risk factor for recurrence in the patient undergoing liver transplantation because of HBV infection.…”

Section: Special Risk Categoriesmentioning

confidence: 99%

Prophylactic Measures in the Solid‐Organ Recipient before Transplantation

Avery

Ljungman²

2001

CLIN INFECT DIS

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Pretransplant screening affords an important opportunity to detect and treat preexisting active infection in the solid-organ transplant recipient. In this article, pretransplant strategies for preventing infections after solid-organ transplantation are reviewed. In addition to the search for active preexisting infection in the transplant candidate, immunization remains a cornerstone of preventive practice. Because there is a suboptimal response to vaccinations in patients who are receiving immunosuppressive therapy, as well as in patients with end-stage organ dysfunction, standard immunization of the transplant candidate should be updated as early as possible in the course of the illness, including pneumococcal, influenza, and hepatitis B vaccines. Liver transplant candidates should receive hepatitis A vaccine, and children should receive Haemophilus influenzae type B conjugate vaccine. All nonimmune pretransplant patients should be considered candidates for the varicella vaccine. The management of special risk groups is discussed in detail.

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Hepatitis B virus infection and liver transplantation.

Cited by 31 publications

References 39 publications

Treatment of hepatitis B and C following liver transplantation

Treatment of hepatitis B and C following liver transplantation

Failure of a reinforced triple course of hepatitis B vaccination in patients transplanted for HBV-related cirrhosis

Prophylactic Measures in the Solid‐Organ Recipient before Transplantation

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