Μanagement of patients with hepatitis B and C before and after liver and kidney transplantation

Table 1 Recommendations for the management of hepatitis B and C infection before and after liver or renal transplantation

	Chronic hepatitis B		Chronic hepatitis C
	Liver transplantation	Kidney transplantation	Liver transplantation	Kidney transplantation
Pre transplant	NAs1		Peg IFN ± RBV ± DAAs3 (depending on genotype and type of DAA)	PegIFN plus very low dose RBV (plus DAAs)4
Post transplant	Prophylaxis and treatment		No prophylaxis2
	Short term HBIG plus NA	NAs1	Peg IFN ± RBV ± DAAs3 (depending on genotype and type of DAA)	Peg IFN plus very low dose RBV

¹Entecavir or tenofovir are the advisable NAs in adjusted doses regarding creatinine clearance;

²Therapy is indicated in fulminant cholestatic hepatitis and de novo glomerulonephritis;

³Records for boceprevir, telaprevir and sofosbuvir. Τriple combination is preferable in cases of cirrhosis (METAVIR fibrosis stages 3 and 4), cholestatic hepatitis, previous virological failure and in the presence of predictors of poor response;

⁴There are only cases for the use of DAAs in renal transplant candidates. HBV: Hepatitis B virus; HCV: Hepatitis C virus; NA: Nucleos(t)ide analog; HBIG: Hepatitis virus immunoglobulin; DAAs: Direct oral acting antivirals; Peg IFN: Peg interferon; RBV: Ribavirin.