Hepatitis B virus cellular immunity after liver transplantation: A role in preventing hepatitis B virus recurrence?

✍ Scribed by Anne Marie Roque-Afonso

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 67 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21729

✦ Synopsis

Chronic hepatitis B virus (HBV) infection is a common cause of advanced liver disease and hepatocellular carcinoma and has become a worldwide public health issue. Liver transplantation (LT) is the most effective therapeutic option for HBV-infected patients who have acute or chronic liver failure and/or primary liver cancer. In the absence of prophylactic measures, the risk of HBV recurrence is about 80% and is principally related to the viral load at the time of transplantation. Advances in antiviral prophylaxis have achieved the prevention of clinically significant graft reinfection for the majority of patients. 1 The first major advance was the use of long-term hepatitis B immune globulin (HBIG). Variable protocols are applied by different transplantation centers with respect to the dosing and administration route of HBIG, and HBIG failure is observed in Ͼ30% of patients at 5 years, mainly in patients who had high viral loads at the time of transplantation. In some cases, relapse is associated with variants bearing a mutation within the "a determinant" of hepatitis B surface (HBs) antigen. 1 Lamivudine as single-agent prophylaxis can also prevent significant graft reinfection. Failure of prophylaxis occurs during the first 2 years post-LT in about 30% of patients, most likely in those with a high viral load before lamivudine treatment and at the time of LT. In most cases, relapse is associated