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Management of HBV Infection in Liver Transplantation Patients
In the absence of preventative therapy, reinfection of allografts with hepatitis B virus (HBV) after orthotopic liver transplantation (OLT) resulted in dismal allograft and patient survival. Major advances in the management of HBV-infected recipients of OLT during the past 15 years have steadily red...
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Formato: | Texto |
Lenguaje: | English |
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Ivyspring International Publisher
2005
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142224/ https://www.ncbi.nlm.nih.gov/pubmed/15968339 |
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author | Vierling, John M. |
author_facet | Vierling, John M. |
author_sort | Vierling, John M. |
collection | PubMed |
description | In the absence of preventative therapy, reinfection of allografts with hepatitis B virus (HBV) after orthotopic liver transplantation (OLT) resulted in dismal allograft and patient survival. Major advances in the management of HBV-infected recipients of OLT during the past 15 years have steadily reduced the rate of reinfection, resulting in improved outcomes. Initially, long-term use of hepatitis B immune globulin (HBIG) as a source of anti-HBs antibodies was effective in preventing or delaying reinfection. Lamivudine monotherapy made it possible to suppress HBV replication prior to OLT, markedly decreasing the risk of reinfection. Although lamivudine monotherapy used before and after OLT could prevent reinfection, its effectiveness was limited by progressive development of lamivudine-resistant mutant infections. Combination therapy with HBIG and lamivudine after OLT reduced both HBV recurrence and the risk of lamivudine resistance even in patients with active HBV replication. Introduction of adefovir provided a safe, alternative oral antiviral able to treat effectively lamivudine-resistant mutants HBV. Available strategies to prevent reinfection have resulted in OLT outcomes for HBV-infected patients comparable to those for patients transplanted for non-HBV indications. In the future, combination therapies of HBIG and both nucleoside and/or nucleotide agents will undoubtedly be optimized. Development of new drugs to treat HBV will increase opportunities to combine agents to enhance safety, efficacy and prevent emergence of HBV escape mutants. New vaccines and adjuvants may make it possible to generate anti-HBs in immunosuppressed patients, eliminating the need for HBIG. |
format | Text |
id | pubmed-1142224 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2005 |
publisher | Ivyspring International Publisher |
record_format | MEDLINE/PubMed |
spelling | pubmed-11422242005-06-17 Management of HBV Infection in Liver Transplantation Patients Vierling, John M. Int J Med Sci Review In the absence of preventative therapy, reinfection of allografts with hepatitis B virus (HBV) after orthotopic liver transplantation (OLT) resulted in dismal allograft and patient survival. Major advances in the management of HBV-infected recipients of OLT during the past 15 years have steadily reduced the rate of reinfection, resulting in improved outcomes. Initially, long-term use of hepatitis B immune globulin (HBIG) as a source of anti-HBs antibodies was effective in preventing or delaying reinfection. Lamivudine monotherapy made it possible to suppress HBV replication prior to OLT, markedly decreasing the risk of reinfection. Although lamivudine monotherapy used before and after OLT could prevent reinfection, its effectiveness was limited by progressive development of lamivudine-resistant mutant infections. Combination therapy with HBIG and lamivudine after OLT reduced both HBV recurrence and the risk of lamivudine resistance even in patients with active HBV replication. Introduction of adefovir provided a safe, alternative oral antiviral able to treat effectively lamivudine-resistant mutants HBV. Available strategies to prevent reinfection have resulted in OLT outcomes for HBV-infected patients comparable to those for patients transplanted for non-HBV indications. In the future, combination therapies of HBIG and both nucleoside and/or nucleotide agents will undoubtedly be optimized. Development of new drugs to treat HBV will increase opportunities to combine agents to enhance safety, efficacy and prevent emergence of HBV escape mutants. New vaccines and adjuvants may make it possible to generate anti-HBs in immunosuppressed patients, eliminating the need for HBIG. Ivyspring International Publisher 2005-01-05 /pmc/articles/PMC1142224/ /pubmed/15968339 Text en © Ivyspring International Publisher. This is an open access article distributed under the terms of a Creative Commons License (http://creativecommons.org/licenses/by-nc-nd/2.0) which permits the distribution and reproduction for non-commercial purposes, provided that the article is in whole, unmodified, and properly cited. |
spellingShingle | Review Vierling, John M. Management of HBV Infection in Liver Transplantation Patients |
title | Management of HBV Infection in Liver Transplantation Patients |
title_full | Management of HBV Infection in Liver Transplantation Patients |
title_fullStr | Management of HBV Infection in Liver Transplantation Patients |
title_full_unstemmed | Management of HBV Infection in Liver Transplantation Patients |
title_short | Management of HBV Infection in Liver Transplantation Patients |
title_sort | management of hbv infection in liver transplantation patients |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142224/ https://www.ncbi.nlm.nih.gov/pubmed/15968339 |
work_keys_str_mv | AT vierlingjohnm managementofhbvinfectioninlivertransplantationpatients |