What is the optimal regimen for preventing hepatitis B recurrence after liver transplantation?

The outcome of liver transplantation for hepatitis B has markedly improved in the last two decades. This commentary discusses the findings and limitations of a study by Hwang et al., which retrospectively examined the outcome of 639 adult patients who underwent living donor liver transplantation for hepatitis B. The authors reported a 5-year HBV recurrence rate of 7.3% and concluded that high-dose hepatitis B immunoglobulin (HBIG) monotherapy and rescue antiviral therapy is an effective way to prevent HBV recurrence after liver transplantation. With the availability of safe and effective antiviral agents associated with low rates of drug resistance, HBIG monotherapy is rarely used. The standard approach involves administration of antiviral therapy to suppress HBV replication before transplantation, followed by a combination of HBIG and antiviral therapy after transplantation. Combination prophylaxis permits the dose of HBIG to be reduced, which results in cost savings and reduces rates of HBV recurrence.