Prevention of hepatitis B virus recurrence

Abstract

Despite universal vaccination and antiviral therapies being available for decades, chronic hepatitis B (CHB) remains the leading primary liver disease for liver transplantation in many parts of the Asia-Pacific region. The main indications include decompensated cirrhosis, severe acute flares, and hepatocellular carcinoma. Liver transplantation is not a sterilizing cure for CHB infection, therefore long-term antiviral prophylaxis is required. As the virus is never completely eradicated after transplant, the main goal of antiviral prophylaxis is to prevent reactivation, rather than recurrence or reinfection. Current available antiviral prophylaxis using nucleos(t)ide analogs (NUCs) ± hepatitis B immunoglobulin (HBIG) are highly effective in preventing HBV reactivation after liver transplantation. Only NUCs with high potency and high barriers to resistance should be used, as there is still a risk of developing resistance and subsequent virological rebound and reactivation for older NUCs. Over the past decade, there has been a trend towards using less HBIG, with HBIG-free regimens showing excellent long-term outcomes and survival. Although cessation of prophylaxis may be feasible in a highly selected group, this should only be attempted within clinical trial settings, and life-long prophylaxis is still recommended. Future novel agents may restore the immune control of HBV, whereby antiviral therapy can be safely discontinued.

Keywords

Hepatitis B / hepatocellular carcinoma / recurrence / prophylaxis / antiviral

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