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World J Gastroenterol. Dec 28, 2013; 19(48): 9189-9197
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9189
Review of the pharmacological management of hepatitis B viral infection before and after liver transplantation
Evangelos Cholongitas, George V Papatheodoridis
Evangelos Cholongitas, the 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
George V Papatheodoridis, Department of Gastroenterology, Athens University Medical School, Laiko General Hospital of Athens, 11527 Athens, Greece
Author contributions: Cholongitas E performed the literature search, wrote the first draft of the manuscript and approved the final version; Papatheodoridis GV edited the final draft of the manuscript and approved the final version.
Correspondence to: Dr. Evangelos Cholongitas, Lecturer of Internal Medicine, the 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 49, Konstantinopoleos Street, 54642 Thessaloniki, Greece. cholongitas@yahoo.gr
Telephone: +30-231-892110 Fax: +30-231-855566
Received: September 14, 2013
Revised: October 29, 2013
Accepted: November 18, 2013
Published online: December 28, 2013
Processing time: 122 Days and 18.9 Hours
Abstract

The progress in treatment against hepatitis B virus (HBV) with the development of effective and well tolerated nucleotide analogues (NAs) has improved the outcome of patients with HBV decompensated cirrhosis and has prevented post-transplant HBV recurrence. This review summarizes updated issues related to the management of patients with HBV infection before and after liver transplantation (LT). A literature search using the PubMed/Medline databases and consensus documents was performed. Pre-transplant therapy has been initially based on lamivudine, but entecavir and tenofovir represent the currently recommended first-line NAs for the treatment of patients with HBV decompensated cirrhosis. After LT, the combination of HBV immunoglobulin (HBIG) and NA is considered as the standard of care for prophylaxis against HBV recurrence. The combination of HBIG and lamivudine is related to higher rates of HBV recurrence, compared to the HBIG and entecavir or tenofovir combination. In HBIG-free prophylactic regimens, entecavir and tenofovir should be the first-line options. The choice of treatment for HBV recurrence depends on prior prophylactic therapy, but entecavir and tenofovir seem to be the most attractive options. Finally, liver grafts from hepatitis B core antibody (anti-HBc) positive donors can be safely used in hepatitis B surface antigen negative, preferentially anti-HBc/anti-hepatitis B surface antibody positive recipients.

Keywords: Hepatitis B virus; Liver transplantation; Hepatitis B virus immunoglobulin; Antivirals; Lamivudine; Adefovir; Entecavir; Tenofovir; Telbivudine; Resistance

Core tip: In the present review the current knowledge on the management of hepatitis B virus (HBV) infection before and after liver transplantation is updated. There is no doubt that all HBV patients with decompensated cirrhosis should be treated with potent anti-HBV agents with high genetic barrier (i.e., entecavir or tenofovir). After liver transplantation, the combination of HBV immunoglobulin (HBIG) (at least for a certain period) and entecavir or tenofovir currently appears to be the most reasonable approach, while HBIG-free antiviral prophylaxis cannot be excluded in the future, particularly in patients with low risk of recurrence.