HEPATITIS B VIRUS AND LIVER TRANSPLANTATION

Abstract

Hepatitis B virus (HBV) infection affects more than 300 million persons worldwide and is ranked among the top 10 lethal infectious diseases by the World Health Organization. 45 Liver transplantation is the treatment of choice for patients with liver failure caused by acute or chronic HBV-related liver disease. Early experience with liver transplantation of hepatitis B–infected patients was discouraging. 99 Recurrent HBV infection was common and associated with an aggressive clinical course leading to graft loss and even death within the first few years following transplantation. As a result, HBV infection came to be regarded as a relative contraindication for liver transplantation in many transplant programs, and the proportion of liver transplants performed for HBV-related cirrhosis declined from 5.8% in 1990 to 3.6% in 1993 (Fig. 1) . 102 Therapies, such as hepatitis B immunoglobulin (HBIg), lamivudine , and famciclovir , have significantly improved outcomes by reducing the frequency of recurrent HBV infection and increasing graft and patient survival. 46 , 80 , 96 Consequently, HBV infection is no longer a contraindication for liver transplantation in most transplant programs, and attitudes regarding the treatment options available for HBV-infected patients are optimistic. This article reviews the natural history of HBV infection in liver transplant recipients, and the pathology, pathogenesis, and treatment of post-transplant hepatitis.