Management of Patients with Chronic Hepatitis B Before and After Liver Transplantation: An Update

The use of newer and more potent antiviral agents against hepatitis B virus (HBV) results in greater viral suppression; however, liver transplantation is still required for complications of HBV infection. Post-transplant outcomes for HBV-related disorders are currently comparable to or slightly better than for other indications for liver transplantation in adults in the United States. In the absence of prophylactic antiviral therapy, recurrent HBV infection occurs invariably in patients with detectable serum HBV-deoxyribonucleic acid (DNA) at the time of transplantation, leading to poorer outcomes with severe graft injury, reduced patient and allograft survival. Therefore, anti-HBV therapy is indicated in all patients with detectable serum HBV-DNA pre-transplantation and prophylactic therapy to prevent recurrent HBV infection is standard-of-care. This review summarizes available evidence for the use of different antiviral agents before liver transplantation, the effectiveness of prophylactic agents in preventing recurrent HBV infection post-liver transplantation, and the efficacy of several regimens for treating recurrent HBV infection post-liver transplantation