Prevention of hepatitis B recurrence after liver transplantation

The reults of orthotopic liver transplantation (OLT) for hepatitis B virus (HBV) related liver disease are significantly influenced by the HBV recurrence rate. Complete eradication of hepatitis B is rarely possible after liver transplantation and hepatic and extrahepatic reservoirs are a continuous latent source of HBV recurrence. Therefore an adequate prophylaxis is mandatory. By introduction of long term passive immunoprophylaxis the recurrence rate could be markedly reduced and survival rates significantly improved. Due to the approval of antiviral drugs, especially lamivudine as the first approved antiviral agent against HBV, new prophylactic options, including combination prophylaxis, have been introduced. This modern antiviral management improved the outcome of hepatitis B patients after liver transplantation. The Results after OLT are nowadays reported to be as good or in a recent UNOS database report even better than in non-HBV patients. The type of recommended prophylaxis has undergone modifications within the last years and is still subject to changes due to the ongoing development of antiviral agents. In addition, due to high costs of hepatitis immunoglobulin alternatives such as prophylaxis with nucleos(t)ide analogues or vaccination are increasingly investigated. In the following, current strategies of reinfection prophylaxis and future perspectives are reviewed.