HBV/HDV management after liver transplantation: Review

Abstract

Chronic hepatitis B is a worldwide health problem. Hepatitis D virus (HDV) is a dependent virus that relies on hepatitis B virus (HBV) to synthesize the pathogenic genomes. This may lead to HDV and HBV coinfection or superinfection that results in rapid liver damage that may lead to various serious complications, such as acute liver failure, cirrhosis, and hepatocellular cancer requiring liver transplantation. However, post-transplant HBV reactivation is always a concern as it can be detrimental to allograft function, leading to poor survival. The mainstay strategy to prevent this has been prophylaxis with hepatitis B immunoglobulin (HBIG) and potent anti-viral drugs. This treatment option has been investigated over the years in terms of appropriate dosing, duration and combination. Furthermore, with the advent of more potent antivirals there have been suggestions to use them as a monotherapy. Although, currently there is no effective therapy available for HDV, but the success of the liver transplantation in these patients is dependent on preventing HBV recurrence. Therefore, there has been a continuous effort to come up with an effective treatment plan that is effective and economical. In this review, we discuss the available treatment options for HBV/HDV after liver transplantation.