Review
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2009; 15(20): 2489-2499
Published online May 28, 2009. doi: 10.3748/wjg.15.2489
Current prophylactic strategies against hepatitis B virus recurrence after liver transplantation
Li Jiang, Li-Sheng Jiang, Nan-Sheng Cheng, Lu-Nan Yan
Li Jiang, Lu-Nan Yan, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Li-Sheng Jiang, Nan-Sheng Cheng, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Jiang L wrote the article; Jiang L, Jiang LS, Cheng NS gathered referenced data; Yan LN designed and reviewed the article.
Correspondence to: Lu-Nan Yan, MD, Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunanhx@163.com
Telephone: +86-28-85422469
Fax: +86-28-85422469
Received: March 7, 2009
Revised: March 31, 2009
Accepted: April 7, 2009
Published online: May 28, 2009
Abstract

Prophylactic strategies against hepatitis B virus (HBV) recurrence after liver transplantation (LT) are essential for patients with HBV-related disease. Before LT, lamivudine (LAM) was proposed to be down-graded from first- to second-line therapy. In contrast, adefovir dipivoxil (ADV) has been approved not only as first-line therapy but also as rescue therapy for patients with LAM resistance. Furthermore, combination of ADV and LAM may result in lower risk of ADV resistance than ADV monotherapy. Other new drugs such as entecavir, telbivudine and tenofovir, are probably candidates for the treatment of hepatitis-B-surface-antigen-positive patients awaiting LT. After LT, low-dose intramuscular hepatitis B immunoglobulin (HBIG), in combination with LAM, has been regarded as the most cost-effective regimen for the prevention of post-transplant HBV recurrence in recipients without pretransplant LAM resistance and rapidly accepted in many transplant centers. With the introduction of new antiviral drugs, new hepatitis B vaccine and its new adjuvants, post-transplant HBIG-free therapeutic regimens with new oral antiviral drug combinations or active HBV vaccination combined with adjuvants will be promising, particularly in those patients with low risk of HBV recurrence.

Keywords: Hepatitis B virus; Liver transplantation; Recurrence; Prophylaxis; Hepatitis B immunoglobulin