HEPATITIS-B INFECTION AND LIVER-TRANSPLANTATION

Patients with chronic hepatitis B virus (HBV) infection hasv historica lly incurred high rates of allograft reinfection from extrahepatic res ervoirs of HBV, with worse long term outcome compared with that of tra nsplant recipients without HBV infection. As a result, chronic HBV inf ection has been considered a contraindication for transplantation. Pro phylaxis against HBV recurrence, in the form of passive immunization w ith high dose hepatitis B hyperimmunoglobulin and the antiviral agent lamivudine, has recently been demonstrated to decrease the risk of rei nfection. With appropriate prophylaxis, liver transplantation can be a viable proposition for patients with HBV infection. Past experience a nd current status of HBV infection and transplantation are reviewed, w ith emphasis on the issues surrounding prophylaxis.