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Prophylactic managements of hepatitis B viral infection inliver transplantation

World Journal of Gastroenterology 2016年第1期22卷 165-175页

作者： takashi onoe Hiroyuki Tahara Yuka Tanaka Hideki Ohdan Division of Applied Immunobiology Institute for Clinical ResearchNational Hospital OrganizationKure Medical Center/Chugoku Cancer CenterHiroshima 737-0023Japan Gastroenterological and Transplant Surgery Applied Life SciencesInstitute of Biomedical and Health SciencesHiroshima UniversityHiroshima 734-8551Japan

Liver transplantation(LT)is a considerably effective treatment for patients with end-stage hepatitis B virus(HBV)-related liver disease.However,HBV infection often recurs after LT without prophylaxis.Since the1990s,the treatment for preventing HBV reinfection after LT has greatly progressed with the introduction of hepatitis B immunoglobulin(HBIG)and nucleos(t)ide analogues(NAs),resulting in improved patient survival.The combination therapy consisting of high-dose HBIG and lamivudine is highly efficacious for preventing the recurrence of HBV infection after LT and became the standard prophylaxis for HBV recurrence.However,mainly due to the high cost of HBIG treatment,an alternative protocol for reducing the dose and duration of HBIG has been evaluated.Currently,combination therapy using low-dose HBIG and NAs is considered as the most efficacious and cost-effective prophylaxis for post-LT HBV reinfection.Recently,NA monotherapy and withdrawal of HBIG from combination therapy,along with the development of new,potent high genetic barrier NAs,have provided promising efficacy,especially for low-risk recipients.This review summarizes the prophylactic protocol and their efficacy including prophylaxis of de novo HBV infection from anti-HBc antibody-positive donors.In addition,challenging approaches such as discontinuation of all prophylaxis and active immunity through hepatitis B vaccination are discussed.

关键词： Liver transplantation Hepatitis B infection prophylaxis nucleos(t)ide analogue anti-hepatitis Bimmunoglobulin

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