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World J Hepatol. Mar 27, 2021; 13(3): 291-299
Published online Mar 27, 2021. doi: 10.4254/wjh.v13.i3.291
Hepatitis D virus and liver transplantation: Indications and outcomes
Haris Muhammad, Aniqa Tehreem, Muhammad Baraa Hammami, Peng-Sheng Ting, Ramzan Idilman, Ahmet Gurakar
Haris Muhammad, Department ofInternal Medicine, Greater Baltimore Medical Center, Towson, MD 21204, United States
Aniqa Tehreem, Department of Internal Medicine, Sinai Hospital Baltimore, MD 21204, United States
Muhammad Baraa Hammami, Peng-Sheng Ting, Ahmet Gurakar, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MA 21205, United States
Ramzan Idilman, Department of Gastroenterology, Ankara University School of Medicine, Ankara 06690, Turkey
Author contributions: Muhammad H, Tehreem A and Hammami MB participated in paper design, literature review and writing of the manuscript; Ting PS and Idilman R contributed to critical review and revisions of the manuscript; Gurakar A contributed in paper design, literature review, critical review and revisions of the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmet Gurakar, MD, Associate Professor, Director, Doctor, Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building, Suite 918, Baltimore, MA 21205, United States. aguraka1@jhmi.edu
Received: November 16, 2020
Peer-review started: November 16, 2020
First decision: January 18, 2021
Revised: January 20, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: March 27, 2021
Processing time: 123 Days and 3.2 Hours
Abstract

Hepatitis D virus (HDV) is a dependent virus that relies on hepatitis B virus for its replication and transmission. Chronic hepatitis D is a severe form of viral hepatitis that can result in end stage liver disease. Currently, pegylated interferon alpha is the only approved therapy for chronic HDV infection and is associated with significant side effects. Liver transplantation (LT) is the only treatment option for patients with end-stage liver disease, hepatocellular carcinoma, or fulminant hepatitis due to coinfection with HDV. As LT for HDV and hepatitis B virus coinfection is uncommon in the United States, most data on the long-term impact of LT on HDV are from international centers. In this review, we discuss the indications and results of LT with treatment options in HDV patients.

Keywords: Hepatitis delta virus, Liver transplant, Hepatitis B immunoglobins, Hepatocellular carcinoma

Core Tip: Hepatitis D virus (HDV) is a dependent virus and relies on hepatitis B virus (HBV) to synthesize the pathogenic genomes. Therefore, it can only survive as a coinfection with HBV or as a superinfection. Chronic HDV infection results in rapid liver damage and can result in end stage liver disease. Currently, pegylated interferon alpha is the only approved therapy for chronic HDV infection and is associated with significant side effects. Thus, liver transplant remains the only option for patients with end-stage liver disease, hepatocellular carcinoma due to coinfection or superinfection with HDV and HBV, fulminant liver failure and those who cannot be treated with interferon-based therapies. Post transplantation reinfection with HDV/HBV is an undesirable outcome. Though, there is a consensus that hepatitis B immune globulin in combination with a potent nucleoside/nucleotide analogue have shown promising results. In addition, there is ongoing research for newer treatment drugs. This review article focuses on liver transplant in patients as a result of hepatitis D virus. We have discussed the epidemiology, pathogenesis, clinical presentation, indication of liver transplantation, treatment options and the outcomes. New therapy trials have been also discussed in the treatment section. We believe that this topic is an area of knowledge gap and this article will cover the basics.