Case studies of the hepatitis B patient: A panel discussion

In recent years, there have been significant advances in the treatment of p atients with hepatitis B who are candidates for liver transplantation. This includes the prevention and management of hepatitis B posttransplantation. However; there is no established protocol for treating these patients. Ult imately: the goal would be to have patients HBV-DNA negative pretransplanta tion and then to prevent HBV recurrence posttransplantation to help ensure their quality of life. Several clinical case scenarios are presented and po ssible treatment solutions have beer? suggested The riming of a transplant is critical due to the risk of viral mutation while the patient is on a nuc leoside analogue antiviral agent and waiting for an organ. One successful o ption might be to start therapy pretransplant and continue it posttransplan t. Combination therapy appears to provide the most effective course of trea tment. This should include a nucleoside analogue and patients should he cov ered with hepatitis B immune globulin throughout the course of therapy. Sev eral other variations of combination therapy are discussed but many clinica l issues remain to be resolved. Guidelines for future studies designed to a nswer these questions are proposed.