A Review of Hepatitis B Management in Pre- and Post-Liver Transplant Recipients

Liver transplantation was approved for treatment of decompensated cirrhosis in the United States in 1983. Hepatitis B and hepatitis C viruses are the leading causes of liver transplantation for viral hepatitis and hepatitis B is also an important cause of liver transplantation for called acute liver failure) due to either acute hepatitis B or an acute exacerbation of chronic hepatitis B. However, until the introduction of hepatitis B immunoglobulin and nucleoside/nucleotide analogues nearly twenty years ago, liver transplantation for hepatitis B was characterized by universal recurrence with a dismal prognosis. The widespread use of oral anti-virals in the US has led to a decreased incidence of decompensated liver disease and patients waitlisted for liver transplantation. Among patients listed for hepatocellular carcinoma, the decrease in waitlist registration was also least dramatic among patients with HBV, possibly related to the use of oral antivirals. At present, liver transplantation for hepatitis B, regardless of whether for decompensated cirrhosis, hepatocellular carcinoma satisfying Milan criteria or acute liver failure has excellent outcomes with results comparable if not better to other liver transplant recipients. This article will review the management of patients with decompensated cirrhosis from HBV prior to liver transplantation, the use of hepatitis B positive donors and the prevention and management of hepatitis B after liver transplantation.