- Data suggests not cure but much lower recurrence of Hepatitis B (HBV) after liver transplantation now compared to the 1980s and early 1990s.
- According to peer-reviewed research (1, 2), these days post-liver transplant HBV recurrence is <10%, though patients may require long-term intravenous infusion of anti-hepatitis B immune globulin.
- For chronic HBV patients who reached the stage where they need a liver transplant, two issues critically determine their prognosis post-transplant,
- One, the type of donor used for the transplant.
- Organ shortage is a critical issue because ideal donors shouldn’t have any indication of HBV exposure, i.e., should be negative for circulating anti-Hepatitis B core antigen (anti-HBc) as well as for circulating Hepatitis B surface antigen (HBsAg).
- Problem with this is local prevalence of HBV infection determines how likely it’d be to find such donors.
- Post-transplant risks for HBV recurrence thus depends on the HBV status of the donor. Risk of post-transplant HBV arises from the fact that if donor had occult HBV infection, it could get activated in the recipient since they’d be on post-transplant immunosuppressive therapy.
- When donors with anti-HBc were used, a meta-analysis of 38 studies (3) showed that patients’ chances of de novo HBV infection post-transplant could be as high as 47.8% if patients didn’t receive immunoprophylaxis, i.e., intravenous infusion of anti-hepatitis B immune globulin (HBIG).
- OTOH, post-transplant immunoprophylaxis reduced probability of de novo infection to 8.2%.
- Two, HBV status of patients also plays a role in post-transplant prognosis. HBV patients with anti-HBc seem to be protected from de novo HBV infection from the graft itself, i.e., circulating anti-HBV antibodies in patients appears to reduce their chances of getting HBV in the transplanted liver (3).
- Lok, Anna Suk‐Fong. “Progress in hepatitis B: A 30‐year journey through three continents.” Hepatology 60.1 (2014): 4-11.
- Degertekin, Bulent, et al. “Impact of virologic breakthrough and HBIG regimen on hepatitis B recurrence after liver transplantation.” American Journal of Transplantation 10.8 (2010): 1823-1833.
- Cholongitas, Evangelos, George V. Papatheodoridis, and Andrew K. Burroughs. “Liver grafts from anti-hepatitis B core positive donors: a systematic review.” Journal of hepatology 52.2 (2010): 272-279.