Transplantation in the hepatitis B patient and current therapies to prevent recurrence

Hepatitis B is the sixth most common indication for liver transplantation i n the United States, accounting for about 7% of all transplants among adult s. Transplantation for hepatitis B is especially problematic be cause the v irus is not eradicated and there is great potential for reinfection that ca n lean to graft failure or death. This risk is higher still in patients wit h active viral replication and chronic liver disease. Treatment with short- term hepatitis B immune globulin (HBIG) delays reinfection of the allograft , but only long-term treatment with HBIG has led to a decline in the reinfe ction rate. Combination therapy using HBIG with nucleoside analogues will l ikely become thc standard of care to maintain stable serum titers of protec tive anti-HBs antibody and to prevent posttransplantation reinfection.