| Theme |
Hepatitis B Update 2004 |
| Title |
Prophylaxis of HBV in Liver Transplantation |
| Author |
Mitsuhiro Asakuma |
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine |
| Author |
Mikiko Ueda |
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine |
| Author |
Koichi Tanaka |
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine |
| [ Summary ] |
Patients undergoing liver transplantation for hepatitis B frequently experience a recurrence of this condition without prophylaxis and the grafted liver becomes cirrhotic within the first two years. Therefore, in the 1980s, liver transplantation for patients with hepatitis B was thought to be contraindicated. Today, hepatitis B is a universally accepted indication for liver transplantation with several prophylactic treatments to prevent recurrence, such as combination therapy with hepatitis B immune globulin (HBIG) and lamivudine. This strategy prevents the recurrence of the hepatitis B virus (HBV) in almost 100% of patients who undergo liver transplantation for hepatitis B. HBIG is also required to prevent HBV transmission, when patients receive liver grafts from donors with positive hepatitis B core antibodies. Although these prophylaxes are effective against the recurrence or transmission of HBV, the continuous administration of HBIG over long periods is very expensive. From the view point of cost versus performance, HBIG discontinuation and active immunization with hepatitis B vaccines is currently being tried in some centers. |