Prevention of Post-transplant HBV

Abstract

Antiviral treatment of hepatitis B virus (HBV) cirrhosis using entecavir or tenofovir suppresses replication of HBV and can reverse liver insufficiency in some cases, which might imply delisting. After liver transplantation, combination HBV prophylaxis with lowdose hepatitis B immune globulin and antivirals effectively prevents HBV recurrence in >90 % of transplant recipients. Some forms of prevention of HBV recurrence should be continued indefinitely post-transplant, but in patients with a low risk of recurrence (i.e., HBV DNA levels undetectable pre-transplant), discontinuation of hepatitis B immune globulin (HBIG) is possible if patients are treated with long-term nucleos(t)ide(s) analogue(s) therapy. A more cautious approach is necessary for patients with high pre-transplant HBV replication, patients with HIV or hepatitis D virus coinfection or preexisting HBV drug resistance, those with a high risk of hepatocellular carcinoma recurrence, and those at risk of noncompliance with antiviral therapy. In this group, HBIG-free prophylaxis cannot be recommended.