Liver transplantation in viral hepatitis: Prevention of recurrence

Of patients undergoing OLT, 10–30% have HBV and HCV infection, respectively. Outcome depends on the prevention of allograft reinfection. The advent of long-term hepatitis B immunoglobulin administration and the introduction of antiviral agents were a major breakthrough in the management of these patients. Today, survival after OLT is similar to that in patients receiving transplants for HBsAg-negative liver disease, and the risk of HBV recurrence is <10%. New antiviral drugs, such as entecavir and tenofovir, as mono or combination therapy will be additional antiviral alternatives pre- and post-transplantation. Several issues warrant further study: testing of prophylactic protocols that utilize lower or shorter HBIG doses in combination with antiviral agents, and evaluation of new antiviral combinations which have low rates of drug resistance. Conversely, HCV reinfection occurs almost invariably, and it significantly impairs patient and graft survival. Factors that may influence progression of HCV graft injury remain unclear. Chronic HCV infection develops in 75–90% of patients, and 5–30% progress to cirrhosis within 5 years. Pre-transplantation and prophylactic post-transplantation antiviral treatment is limited by low applicability and poor tolerance. Treatment of established graft lesions with (peg)interferon and ribavirin combination therapy achieved sustained virological response in 30–45% of patients.