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Prior to the introduction of effective prophylactic therapy, liver transplantation in patients infected with hepatitis B virus (HBV) resulted in high rates of viral recurrence, allograft loss, and mortality. One retrospective study found the risk of HBV recurrence to be as high as 75% in liver transplant patients who were not given immunoprophylaxis.
Therapeutic advances in the past 2 decades have drastically changed the outlook for patients infected with HBV, turning liver transplantation into a routine procedure. The introduction of hepatitis B immunoglobulin (HBIg) and nucleoside analogues has significantly reduced HBV recurrence: with HBIg and lamivudine and/or adefovir combination therapy, the risk of recurrent HBV infection is estimated to be <10%. Combination treatment with HBIg and nucleoside analogues with high genetic barrier to resistance, such as entecavir and tenofovir, reduced the risk of HBV recurrence even more — to <5%. Furthermore, hepatocellular carcinoma, as opposed to liver decompensation, has become the primary indication for liver transplantation.
In an interview with Infectious Disease Advisor, Norah A. Terrault, MD, MPH, professor of medicine and director of the Viral Hepatitis Center at the University of California, San Francisco (UCSF), discussed the recent advances and remaining challenges in managing HBV infection in patients undergoing liver transplantation.