Liver Transplantation in Hepatitis B/Hepatitis D (Delta) Virus Coinfected Recipients

Abstract

Hepatitis D is caused by the hepatitis D virus (HDV); it is the most severe form of viral hepatitis in humans, running an accelerated course to cirrhosis. There is no efficacious therapy, and liver transplantation provides the only therapeutic option for terminal HDV disease. However, HDV infection is prevalent in poor countries of the world with no access to liver transplant programs; liver grafting has been performed in high-income countries, where the prevalence of the infection has much diminished as a secondary effect of hepatitis B virus vaccination, and the demand for liver transplantation outlives in aging cirrhotics who acquired hepatitis D decades ago. This review describes the evolution of liver transplantation for HDV disease from its inception in 1987 to the present time, with an outlook to its future. It reports the progress in the prophylaxis of HDV reinfections to the success of the current standard of indefinite combination of hepatitis B virus antivirals with immunoglobulins against the hepatitis B surface antigen; however, the unique biology of the virus provides a rationale to reducing costs by limiting the administration of the immunoglobulins against the hepatitis B surface antigen.

Comorbid background on the waiting list for liver transplantation. Clinical case of liver cirrhosis as a result of chronic viral hepatitis B with a delta agent in combination with cardiac arrhythmia

“…hDV вызывает более быстрое прогрессирование заболевания печени, чем один только hbV. приблизительно от 30 до 70% пациентов с hDV на момент постановки диагноза имеет цп, и более 50% умирает от заболевания печени в течение 10 лет после постановки диагноза [12]. однако недавние исследования показали, что прогрессирование варьируется и что более 50% людей может иметь вялотекущее течение.…”

Delta hepatitis epidemiology and the global burden of disease

“…In a European Transplant Registry, with 1939 transplants for HDV reported from 1988 to 2016, although there was a significant decline over time in the number of HBV transplants, there was a much lower rate of decline in HDV transplants, suggesting that advanced disease as a result of lack of effective therapies may be leading to advanced disease necessitating transplant 33 . Although HDV recurrence in transplant recipients has been described, contemporary approach to post‐transplant prophylaxis with nucleoside analogue and HBIG appears to be highly effective in providing virologic control 34 …”

“…33 Although HDV recurrence in transplant recipients has been described, contemporary approach to post-transplant prophylaxis with nucleoside analogue and HBIG appears to be highly effective in providing virologic control. 34 In addition to clinical outcomes, patient-reported outcomes (PROs) have also been evaluated among individuals with HDV. In a study conducted in Spain evaluating PROs among HDV versus HBV mono-infected patients, patients with chronic HDV scored worse on the worry score, functional well-being score and the activity impairment score compared to patients with chronic HBV.…”

The role of HBIG in real life for patients undergoing liver transplantation due to HDV‐related cirrhosis

“…7 Nonetheless, some studies have shown that HDV may protect against HBsAg recurrence after LT 8 and that HBV suppression with NAs would prevent full HBV reactivation, precluding HDV recurrence. 9,10 The latter would imply that life-long HBIG administration may not be necessary.…”

“…To prevent HBsAg reappearance, which may in turn facilitate relapse of hepatitis D, most experts recommend lifelong prophylaxis 7 . Nonetheless, some studies have shown that HDV may protect against HBsAg recurrence after LT 8 and that HBV suppression with NAs would prevent full HBV reactivation, precluding HDV recurrence 9,10 . The latter would imply that life‐long HBIG administration may not be necessary.…”