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Review article: preventing hepatitis B graft infection in hepatitis B patients after liver transplantation: immunoglobulin vs anti‐virals
Author(s) -
Park James S.,
Gayam Vijay,
Pan Calvin Q.
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15999
Subject(s) - medicine , hepatitis b immune globulin , hepatitis b , viral hepatitis , liver transplantation , immunology , hepatitis , hepatitis c , antibody , hepatitis b virus , transplantation , gastroenterology , virus , hbsag
Summary Background A critical aspect of liver transplantation in hepatitis B patients is to prevent graft reinfection with hepatitis B virus. The use of hepatitis B immune globulin after transplant was a significant milestone, which allowed prolonged graft and patient survival by controlling hepatitis B reinfection in liver grafts. The development of anti‐viral treatments with oral nucleos(t)ide analogues, led to a further reduction in graft reinfection and improvement in patient survival. The combination of the aforementioned two therapies has been widely used in hepatitis B‐associated liver transplants. Aims To address the post‐transplant management of hepatitis B and provide updates on preventing graft reinfection. Methods We performed a literature search on Ovid and PubMed for randomised controlled trials or cohort studies in English, which investigated the effectiveness of hepatitis B immune globulin and anti‐viral therapy on hepatitis B‐associated transplants (1/2000‐1/2020). Studies that met pre‐established criteria were reviewed. Results Based on currently available evidence, an algorithm for post‐transplant management with anti‐viral therapy is proposed. Also, the management of recipients who received grafts from hepatitis B core antibody‐positive donors is discussed. Conclusions The development of hepatitis B immune globulin and anti‐viral treatments led to substantial improvement in graft and patient survival. The prevention of hepatitis B graft reinfection is complex and involves a broad interdisciplinary team.