The Role of Antiviral Prophylaxis in Preventing HBV and HDV Recurrence in the Setting of Liver Transplantation

Hepatitis B virus (HBV) is a prevalent underlying disease, leading to liver transplantation (LT) for both decompensated cirrhosis and hepatocellular carcinoma (HCC). The hepatitis delta virus (HDV) affects approximately 5-10% of HBsAg carriers, accelerating the progression of liver injury and HCC. The initial introduction of HBV immunoglobulins (HBIG), and then of nucleos(t)ide analogues (NUCs), considerably improved the survival of HBV/HDV patients post-transplantation, as they helped prevent re-infection of the graft and recurrence of liver disease. Combination therapy with HBIG and NUCs is the primary post-transplant prophylaxis strategy in patients transplanted for HBV- and HDV-related liver disease. However, monotherapy with high-barrier NUCs, such as entecavir and tenofovir, is safe and also effective in some individuals who are at low risk of HBV reactivation. To address the problems of organ shortage, last-generation NUCs have facilitated the use of anti-HBc and HBsAg-positive grafts to meet the ever-increasing demand for grafts.

Automated summary

Hepatitis B virus (HBV) is a prevalent disease leading to liver transplantation (LT) for cirrhosis and hepatocellular carcinoma (HCC) patients. The presence of hepatitis delta virus (HDV) accelerates liver injury and HCC progression in HBsAg carriers. Post-transplantation, combination therapy with HBIG and NUCs has improved patient survival by preventing re-infection and recurrence. High-barrier NUCs like entecavir and tenofovir are safe and effective for low-risk HBV reactivation. Last-generation NUCs allow for the use of anti-HBc and HBsAg-positive grafts due to organ shortage.