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World J Hepatol. May 27, 2014; 6(5): 315-325
Published online May 27, 2014. doi: 10.4254/wjh.v6.i5.315
Μanagement of patients with hepatitis B and C before and after liver and kidney transplantation
Chrysoula Pipili, Evangelos Cholongitas
Chrysoula Pipili, Department of Nephrology, Laiki Merimna, 17343 Athens, Greece
Evangelos Cholongitas, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
Author contributions: Pipili C and Cholongitas E both contributed to this paper.
Correspondence to: Evangelos Cholongitas, Assistant Professor, 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 49, Konstantinopoleos Street, 54642 Thessaloniki, Greece.
Telephone: +30-23-10892110 Fax: +30-23-10992940
Received: December 3, 2013
Revised: March 10, 2014
Accepted: April 16, 2014
Published online: May 27, 2014

New nucleos(t)ide analogues (NAs) with high genetic barrier to hepatitis B virus (HBV) resistance (such as entecavir, tenofovir) have improved the prognosis of patients with HBV decompensated cirrhosis and have prevented HBV recurrence after liver transplantation (LT). NAs are considered the most proper approach for HBV infection in patients under renal replacement therapy but their doses should be adjusted according to the patient’s creatinine clearance. In addition, physicians should be aware of the potential nephrotoxicity. However, patients with chronic hepatitis C and decompensated cirrhosis can receive only one therapeutic option before LT, as well as for Hepatitis C virus (HCV) recurrence after LT, which is the combination of subcutaneous Peg-IFN and ribavirin. Generally, therapy for HCV after renal transplantation should be avoided. Although the optimal antiviral therapy for HCV infection has not been established, attention has turned to a new, oral direct acting antiviral treatment which marks a promising strategy in prognosis and in amelioration of these diseases.

Keywords: Liver transplantation, Kidney transplantation, Hepatitis C, Hepatitis B, Recurrence

Core tip: While nucleos(t)ide analogs (NAs) offer a benign course in patients with hepatitis B virus before and after liver and renal transplantation, there is still scope for improvement. The administration of high genetic barrier NAs such as entecavir or tenofovir pre-transplant and the careful patient selection for hepatitis virus immunoglobulin-free regimens post-transplant contribute to improved medical care and facilitate its provision from a practical standpoint. Concordantly, attention has turned to new treatment strategies regarding hepatitis C virus recurrence after liver and renal transplantation. The addition of oral direct acting antivirals to the existing treatment marks a promising strategy for prognosis amelioration of these patients.