Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.829
Peer-review started: June 29, 2014
First decision: August 6, 2014
Revised: August 31, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: January 21, 2015
Processing time: 205 Days and 20 Hours
Liver transplantation is the only effective treatment for hepatitis B virus (HBV)-related end-stage liver disease. However, without antiviral prophylaxis, the recurrence rate of hepatitis B is as high as 80%-100%, which leads to a 50% mortality rate in the first 2 years after liver transplantation. Combination therapy of hepatitis B immunoglobulin (HBIG) and lamivudine demonstrated a higher efficacy of prophylaxis and further reduced the rate of recurrence to < 10%. The strategy of HBIG combined with lamivudine has been the standard treatment in many centers. However, the high rate of lamivudine resistance and the many disadvantages of HBIG have compelled surgeons to reconsider the long-term efficacy of this strategy for the prevention of HBV reinfection. Recently, new nucleos(t)ide analogues, such as entecavir and tenofovir, have been approved as first-line monotherapies for the treatment of chronic hepatitis B infection. These antiviral medicines have replaced lamivudine as the first choice in the prevention of HBV recurrence after liver transplantation. Various therapies that are composed of entecavir, tenofovir, and lamivudine plus adefovir, with or without HBIG have been adopted in several liver transplant centers. This article reviews the recent advances in prophylaxis for the recurrence of hepatitis B after liver transplantation.
Core tip: The strategy of hepatitis B immunoglobulin (HBIG) combined with lamivudine has been the standard treatment for the prophylaxis of hepatitis B virus recurrence after liver transplantation. However, the high rate of lamivudine resistance and the many disadvantages of HBIG have compelled surgeons to reconsider the long-term efficacy of this strategy for the prevention of hepatitis B virus reinfection. This review discusses new strategies for prophylaxis of the recurrence of hepatitis B after liver transplantation.