Hepatitis B vaccination and preemptive treatment of hepatitis B virus in liver transplantation

Abstract

PURPOSE OF REVIEW: The risk of de-novo hepatitis B virus infection from the use of hepatitis B core antibody-positive liver grafts has been reported to vary from 16 to 50%, leading to many transplant centres excluding the use of hepatitis B core antibody-positive livers, severely limiting the number of available livers. This paper reviews the use of a prophylactic regimen to prevent the occurrence of de-novo hepatitis B after liver transplantation. RECENT FINDINGS: Combination prophylaxis with human immune globulin and lamivudine was found to reduce the occurrence of hepatitis B in recipients of hepatitis B core antibody-positive liver grafts. Whether lamivudine monoprophylaxis alone is adequate in preventing de-novo hepatitis B from hepatitis B core antibody-positive liver allografts still requires investigation. Additional studies have found that protective titres of hepatitis B surface antibody can protect against de-novo hepatitis B. The results of vaccinating cirrhosis patients awaiting liver transplantation have so far been disappointing. Third-generation hepatitis B vaccine containing pre-S1/S2 recombinant antigens may improve success rates. SUMMARY: Future studies should focus on establishing the best prophylactic regimen for the prevention of hepatitis B so that the donor pool can be expanded to include hepatitis B core antibody-positive donors. © 2006 Lippincott Williams & Wilkins, Inc.