Reactivation of hepatitis B after liver transplantation: Current knowledge, molecular mechanisms and implications in management

Figure 1 Stepwise approach of anti-hepatitis B core positive grafts allocated to recipients based on their hepatitis B serology. In chronic hepatitis B patients with HBsAg positive and who receive Anti-HBc positive liver grafts should be treated with HBIG and nucleoside analogs. If the recipient is HBsAg negative and Anti-HBc positive and/or anti HBs positive, NA is used for prophylaxis based on anti HBc and anti HBs serologies. No prophylaxis is recommended for anti-HBc positive and anti-HBs positive liver in LT recipient without HBsAg positive serology. These patients should be followed with periodic HBV DNA level guided by ALT to monitor for any relapse. In Hepatitis B naïve patients, NA is recommended for prophylaxis. HBIG: Hepatitis B Immunoglobulin; HBsAg: Hepatitis B surface antigen; Anti-HBs: Hepatitis B surface antibody; Anti-HBc: Hepatitis B core antibody.