Strategies for the prevention of recurrent hepatitis B virus infection after liver transplantation.

Hepatitis B virus (HBV) infection is an international public health concern, and chronic infection can lead to the development of cirrhosis, liver failure, or hepatocellular carcinoma as well as the need for liver transplantation. The recurrence of HBV infection following liver transplantation was disproportionately high prior to the introduction of proper prophylactic treatment. Risk factors associated with the recurrence of HBV infection post-transplant include hepatitis B e antigen positivity, high levels of serum HBV DNA, and the presence of an antiviral drug-resistant strain prior to transplantation. The prevention of HBV recurrence began with the introduction of hepatitis B immunoglobulin (HBIG) in the early 1 990s. Nucleos(t)ide analog (NA) antiviral drugs were next to be introduced and, in combination with HBIG, are considered to be extremely effective for the prevention of recurrence. Because of concerns with HBIG, whether HBIG can be used for a short time or discontinued altogether is under debate. All of the NA antiviral drugs have been proven to be effective against HBV, at least in the pretransplant setting, and can be used safely posttransplant. Further investigation is still needed to standardize treatment in the posttransplant setting.