Description

Patients with hepatitis B viral infection may have disease recurrence after orthotopic liver transplantation. Certain factors favor recurrence, while others factors reduce the risk. The immunosuppression required to prevent rejection can favor infection once initiated.


Parameter

Finding

Effect on Risk for Recurrence

reason for transplant

cirrhosis

increase

 

fulminant hepatic failure

decrease

 

retransplantation for graft failure due to recurrent HBV infection

increase

viral coinfection (HCV and/or HDV)

present

neutral

 

absent

increase

high replicative status (HbeAg or HBV DNA) prior to transplant

present

increase

 

absent

neutral

antiviral therapy with transplantation

high dose HBIG (hepatitis B immune globulin)

decrease

 

lamivudine, other antiviral agents

decrease

 

Patients with recurrent HBV infection after transplantation tend to have a worse survival than other patients undergoing liver transplantation.

 

The use of immune globulin in combination with antiviral agents has markedly improved the prognosis of patients with HBV undergoing liver transplantation.

 


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