Role of liver transplantation in patients with hepatitis B infection

Liver transplantation is currently considered definitive therapy for end-stage liver disease. The hepatitis B virus (HBV) affects a large group of candidates for liver transplantation, however, liver transplantation for HBV is associated with unique and serious problems due to post-transplant predisposition for HBV re-infection of the allograft. Patients with actively replicating HBV infection, as demonstrated by positive pre-transplant hepatitis surface antigen (HBsAg), hepatitis e antigen (HBeAg), and HBV-DNA, patients retransplanted for HBV infection, patients not receiving long term hepatitis B immunoglobulin (HBIG) therapy, and patients of Asian descent, appear to be most likely to experience clinically significant recurrent hepatitis. Recurrent HBV can produce acute or chronic liver disease leading to graft failure, retransplantation, or death. For these reasons, liver transplantation for HBV remains controversial. In this review, we describe the proposed mechanisms, predisposing factors, and clinical presentation associated with HBV recurrence in liver allograft recipients. We also discuss current and potential methods of prevention of HBV infection following liver transplantation.