Hepatitis B infection and liver transplantation

Abstract

Patients with chronic hepatitis B virus (HBV) infection have historically incurred high rates of allograft reinfection from extrahepatic reservoirs of HBV, with worse long term outcome compared with that of transplant recipients without HBV infection. As a result, chronic HBV infection has been considered a contraindication for transplantation. Prophylaxis against HBV recurence, in the form of passive immunization with high dose hepatitis B hyperimmunoglobin and the antiviral agent limivudine, has recently been demonstrated to decrease the risk of infection. With appropriate prophylaxis, liver transplantation can be a viable proposition for patients with HBV infection. Past experience and current status of HBV infection and transplantation are reviewed, with emphasis on the issues surrounding prophylaxis.