Tratamiento de la reactivación del virus de la hepatitis B en el trasplante

Abstract

The indication for liver transplantation for those with hepatitis B virus (HBV) infection represents some 5%–10%, with a declining trend, due in large measure to the efficacy of antiviral drugs. Similarly, the use of nucleoside/nucleotide analogues, with or without specific gamma globulin, has helped prevent HBV infection recurrence. The posttransplantation recurrence of HBV infection can be defined as the reappearance of circulating HBsAg and HBV DNA detectable in 2 measurements. Treatment is based on the use of nucleoside/nucleotide analogues, as with patients who have not been transplanted, and is based on the same principles. Profound immunosuppression of patients with liver transplants causes the HBV DNA levels to be very high and requires rapid and effective viral replication suppression. Entecavir and tenofovir are the first-line treatments. Tenofovir is effective for treatment-naïve patients and those with lamivudine-resistance. Entecavir is highly effective for treatment-naïve patients but should be restricted in cases of prior treatment with lamivudine.