Abstract
Organ transplantation in the HBsAg-positive patient is effective and life-saving, but the prevention or management of hepatitis B virus (HBV) recurrence and/or reactivation has been a challenge. For liver transplant recipients, high genetic barrier nucleos(t)ide analogue (Nuc) plus HBIG is still the standard of care to prevent HBV recurrence after transplantation. HBIG discontinuation after a period of time after liver transplantation seems to be safe, but might lead to a higher HBsAg reappearance rate. The clinical significance and long-term outcome of HBsAg reappearance after liver transplantation needs to be further elucidated. HBV has conferred a high risk of morbidity and mortality in other organ transplant recipients except liver. At present, general consensus is that Nuc therapy should be commenced pre-transplant in those with active hepatitis B and start at time of transplant in those without active hepatitis B as the majority of patients will have increase in HBV DNA under immunosuppression. Considering long-term treatment, antiviral agents with a high genetic barrier to resistance (ETV or TDF) and lack of nephrotoxicity (e.g., ETV) are recommended.
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