Abstract
Hepatitis B and C often progress to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT). After OLT, hepatitis B recurrence is clinically controlled with a combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues. Another approach is to induce self-producing anti-hepatitis B virus (HBV) antibodies using a HBV envelope antigen vaccine. Patients who had not been HBV carriers such as acutely infected liver failure or who received liver from HBV self-limited donor are good candidate. For chronic HBV carrier patients, a successful response can only be achieved in selected patients such as those treated with experimentally reduced immunosuppression protocols or received an anti-HBV adaptive memory carrying donor liver. Hepatitis C virus (HCV) reinfects transplanted livers at a rate of >90%. HCV reinfected patients show different severities of hepatitis, from mild and slowly progressing to severe and rapidly progressing, possibly resulting from different adaptive immune responses. More than half the patients require interferon treatment, although the success rate is low and carries risks for leukocytopenia and rejection. Managing the immune response has an important role in controlling recurrent hepatitis C. This study aimed to review the adaptive immune response in post-OLT hepatitis B and C.
Highlights
Hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection are the main causes of end-stage liver disease requiring orthotopic liver transplantation (OLT)
The post-OLT hepatitis B recurrence rate is >80% without any prevention, while >90% of recurrent infections can be controlled with a combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogues (NAs) [1]
These results suggest that pre-OLT HBV vaccination for candidate living donors might facilitate improved post-OLT vaccine responses in recipients with liver cirrhosis
Summary
Hepatitis B virus (HBV) infection and hepatitis C virus (HCV) infection are the main causes of end-stage liver disease requiring orthotopic liver transplantation (OLT). Non-OLT chronic hepatitis B patients are treated with antiviral proliferative NA agents, with >90% long-term control with minute side effects. As HBIG combination therapy has important roles, the B-cell-related adaptive immune response appears to play a role in controlling HBV after OLT. HCV reinfects >90% of patients, with more than half of these patients developing chronic hepatitis requiring interferon- (IFN-) based antiviral treatment [8]. Non-OLT chronic hepatitis C patients have been treated with IFN-based immune reaction-related treatment. Single Peg-IFN resulted in only 30% of patients experiencing sustained viral response (SVR), representing undetectable HCV-RNA longer than 24 weeks after finishing IFN [10] This demonstrated >99% viral eradication, while the Peg-IFN and ribavirin combination resulted in 50% SVR [10, 11]. We summarize the aberrant immune system in HBV- and HCV-related hepatitis, together with the changes in these diseases after OLT
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