Prevention of recurrence of hepatitis B virus infection after liver transplantation.

Hepatitis B virus (HBV) infection is still an important cause of cirrhosis, hepatocellular carcinoma and acute liver failure worldwide, and orthotopic liver transplantation (OLT) is the only effective treatment for many of these conditions. Until recently, however, OLT in patients with HBV infection was associated with a high rate of graft loss due to viral recurrence. The use of long term passive immunoprophylaxis with high dosage human polyclonal immunoglobulin against HBV (HBIg) has, for the first time, allowed favourable outcomes after OLT in a selected group of patients, but this treatment is associated with high cost and questionable efficacy in patients with high viral loads. In the last few years alternative approaches have arisen, namely the use of the reverse transcriptase inhibitor lamivudine and the induction of anti-HBV seroconversion by HBV vaccination as a means of discontinuing HBIg treatment. In this article we review the advantages and drawbacks of each of these prophylactic strategies, particularly emphasising the viability of administering HBV vaccination to these patients.