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World J Gastroenterol. Jan 21, 2015; 21(3): 829-835
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.829
Recent advances in prevention of hepatitis B recurrence after liver transplantation
Zhi-Feng Xi, Qiang Xia
Zhi-Feng Xi, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Author contributions: Xi ZF designed the research and wrote the paper; and Xia Q coordinated the research and approved the final manuscript for publication.
Supported by Shanghai Jiaotong University School of Medicine Science and Technology Fund, No. 11XJ21016; and Training Program for Super Academic Leaders in the Shanghai Health System, No. XBR2011029.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qiang Xia, Professor, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, No. 160 Pujian Road, Shanghai 200127, China. xiaqiang@medmail.com.cn
Telephone: +86-21-68383775 Fax: +86-21-58737232
Received: June 29, 2014
Peer-review started: June 29, 2014
First decision: August 6, 2014
Revised: August 31, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: January 21, 2015
Abstract

Liver transplantation is the only effective treatment for hepatitis B virus (HBV)-related end-stage liver disease. However, without antiviral prophylaxis, the recurrence rate of hepatitis B is as high as 80%-100%, which leads to a 50% mortality rate in the first 2 years after liver transplantation. Combination therapy of hepatitis B immunoglobulin (HBIG) and lamivudine demonstrated a higher efficacy of prophylaxis and further reduced the rate of recurrence to < 10%. The strategy of HBIG combined with lamivudine has been the standard treatment in many centers. However, the high rate of lamivudine resistance and the many disadvantages of HBIG have compelled surgeons to reconsider the long-term efficacy of this strategy for the prevention of HBV reinfection. Recently, new nucleos(t)ide analogues, such as entecavir and tenofovir, have been approved as first-line monotherapies for the treatment of chronic hepatitis B infection. These antiviral medicines have replaced lamivudine as the first choice in the prevention of HBV recurrence after liver transplantation. Various therapies that are composed of entecavir, tenofovir, and lamivudine plus adefovir, with or without HBIG have been adopted in several liver transplant centers. This article reviews the recent advances in prophylaxis for the recurrence of hepatitis B after liver transplantation.

Keywords: Liver transplantation, Hepatitis B recurrence, Hepatitis B immunoglobulin, Lamivudine, Entecavir, Tenofovir

Core tip: The strategy of hepatitis B immunoglobulin (HBIG) combined with lamivudine has been the standard treatment for the prophylaxis of hepatitis B virus recurrence after liver transplantation. However, the high rate of lamivudine resistance and the many disadvantages of HBIG have compelled surgeons to reconsider the long-term efficacy of this strategy for the prevention of hepatitis B virus reinfection. This review discusses new strategies for prophylaxis of the recurrence of hepatitis B after liver transplantation.