ROLE OF LIVER-TRANSPLANTATION IN PATIENTS WITH HEPATITIS-B INFECTION

Liver transplantation is currently considered definitive therapy for e nd-stage liver disease (1-4). The hepatitis B virus (HBV) affects a la rge group of candidates for liver transplantation (1-4), however, live r transplantation for HBV is associated with unique and serious proble ms due to post-transplant predisposition for HBV re-infection of the a llograft (5-10, 12-14). Patients with actively replicating HBV infecti on, as demonstrated by positive pre-transplant hepatitis surface antig en (HBsAg), hepatitis e antigen (HBeAg), and HBV-DNA, patients retrans planted for HBV infection, patients not receiving long term hepatitis B immunoglobulin (HBIG) therapy (5-10, 12, 14), and patients of Asian descent (15), appear to be most likely to experience clinically signif icant recurrent hepatitis (2, 3, 6-14). Recurrent HBV can produce acut e or chronic liver disease leading to graft failure, retransplantation , or death (2, 3, 5, 13, 14). For these reasons, liver transplantation for HBV remains controversial. In this review, we describe the propos ed mechanisms, predisposing factors, and clinical presentation associa ted with HBV recurrence in liver allograft recipients. We also discuss current and potential methods of prevention of HBV infection followin g liver transplantation.