Hepatitis B virus infection and liver transplantation.

PURPOSE OF REVIEW: Infection with hepatitis B virus (HBV) continues to be a major global cause of acute and chronic liver disease despite the existence of successful vaccine and antiviral therapies. As such, HBV-related liver disease remains one of the most common indications for liver transplantation. An understanding of the pathophysiology of hepatitis B viral infection including the potential sequelae of acute-liver failure, cirrhosis, and hepatocellular carcinoma (HCC) is important to the successful treatment of the patient.

RECENT FINDINGS: A better understanding of the differential immune response to hepatitis B viral infection has identified high hepatitis B viral load and persistent transaminitis to be important, modifiable risk factors for the development and progression of cirrhosis and HCC. Improved posttransplant prophylaxis with antiviral and immunoglobulin therapy has led to a low risk of HBV re-infection and excellent outcomes after liver transplantation for HBV-related liver disease.

SUMMARY: HBV-related liver diseases including acute-liver failure, cirrhosis, and HCC remain important and frequent indications for liver transplantation. With appropriate patient selection and posttransplant prophylaxis, excellent posttransplant outcomes can be achieved.