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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2015; 21(36): 10290-10298
Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10290
Change of strategies and future perspectives against hepatitis B virus recurrence after liver transplantation
Masatoshi Ishigami, Yasuhiro Ogura, Yoshiki Hirooka, Hidemi Goto
Masatoshi Ishigami, Yoshiki Hirooka, Hidemi Goto, Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, Nagoya 466-8550, Japan
Yasuhiro Ogura, Department of Transplant Surgery, Nagoya University School of Medicine, Nagoya 466-8550, Japan
Author contributions: Ishigami M mainly summarized the data of this review and wrote the mansuscript; Ogura Y helped by advising surgical management in this review; Hirooka Y joined the discussion to make this review; and Goto H organized our department and joined the discussion.
Conflict-of-interest statement: No conflict of interest.
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: Masatoshi Ishigami, MD, PhD, Department of Gastroenterology and Hepatology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. masaishi@med.nagoya-u.ac.jp
Telephone: +81-52-7442144 Fax: +81-52-7442175
Received: April 9, 2015
Peer-review started: April 9, 2015
First decision: April 23, 2015
Revised: June 12, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 28, 2015
Abstract

A few decades ago, liver transplantation in patients with chronic hepatitis B virus (HBV) infection was considered a relative contraindication because of the high rate of graft infections and poor prognosis. Since then, remarkable progress was introduced by using nucleos(t)ide analogues and/or hepatitis B immunoglobulin (HBIg) and liver transplantation for HBV-related disease is now becoming one of the good indication. However, high cost burden is the main problem for this combination prophylaxis for a long time use, and this issue should be emerged to be resolved. In this review, we show the progress of post anti-HBV strategies showing the history from introduction of HBIg and nucleos(t)ide analogues to recent new strategies with hepatitis B vaccine or saving or stopping protocols of HBIg, and clarify and discuss how to do for further improvement of prevention strategies with better quality.

Keywords: Liver transplantation, Hepatitis B virus, Prophylaxis, Hepatitis B immunoglobulin, Nucleos(t)ide analogue, Hepatitis B vaccine, Escape mutant

Core tip: Liver transplantation for patients with hepatitis B virus (HBV)-related diseases is made remarkable progress since combination prophylaxis with nucleos(t)ide analogues and hepatitis B immunoglobulin was introduced. This combination prophylaxis is established as the gold standard in these days, however, the biggest problem is the high cost for longer use of these drugs. In this study, we show the history of preventive strategy against HBV after liver transplantation, and discuss what to and how to resolve the issues concerning posttransplant anti-HBV strategies with reported literature.