Liver transplantation for hepatitis B.
Recurrent HBV is almost universal post-LT and is accompanied by significant graft and patient loss in the absence of effective immunoprophylaxis. Hepatitis B immunoglobulin (HBIG) monotherapy and lamivudine monotherapy significantly reduce the rate of recurrent hepatitis B, but recurrent hepatitis B still occurs in up to 25% due to the emergence of resistant mutants. Combination administration of HBIG and lamivudine is more efficacious in preventing recurrent hepatitis B, decreasing recurrence rates of hepatitis B to 0-18% in studies. Future studies to determine the optimal dosing regimen and duration of HBIG and lamivudine and to evaluate the efficacy of newer antivirals such as adefovir dipivoxil in preventing recurrent HBV are needed. Treatment of established recurrent hepatitis B remains problematic. Lamivudine has shown promise during the initial treatment period, but is plagued by rapid development of viral resistance with longer treatment duration. Adefovir dipivoxil appears very promising, and further studies are needed to evaluate its efficacy in the post-liver transplant patient. Interferon-alfa's use in the post-liver transplant patient is limited given the availability of the newer antiviral drugs. Famciclovir and ganciclovir have shown some promise in treating recurrent HBV, but have been replaced by newer agents such as lamivudine and adefovir.