摘要
Liver transplantation remains the only curative option for eligible patients with complications of chronic hepatitis B(CHB) infection,including severe acute hepatitis flares,decompensated cirrhosis,and hepatocellular carcinoma. In general,all patients with CHB awaiting liver transplantation should be treated with oral nucleos(t)ide analogs(NAs) with high barriers to resistance to prevent potential flares of hepatitis and reduce disease progression. After liver transplantation,lifelong antiviral therapy is also required to prevent graft hepatitis,which may lead to subsequent graft loss. Although combination therapy using NA and hepatitis B immune globulin(HBIG) has been the regimen most widely adopted for over a decade,recent studies have demonstrated that newer NAs with low rates of resistance are effective in preventing graft hepatitis even without the use of HBIG,achieving excellent long term outcome. For patients without pre-existing resistant mutations,monotherapy with a single NA has been shown to be effective. For those with resistant strains,a combination of nucleoside analog and nucleotide analog should be used. To date,clinical trials using therapeutic vaccination have shown suboptimal response,as CHB patients likely have an immune deficit against HBV epitopes. Future strategies include targeting different sites of the hepatitis B replication cycle and restoring the host immunity response to facilitate complete viral eradication.
Liver transplantation remains the only curative option foreligible patients with complications of chronic hepatitis B（CHB） infection, including severe acute hepatitis flares,decompensated cirrhosis, and hepatocellular carcinoma.In general, all patients with CHB awaiting liver transplantationshould be treated with oral nucleos（t）ideanalogs （NAs） with high barriers to resistance toprevent potential flares of hepatitis and reduce diseaseprogression. After liver transplantation, lifelong antiviraltherapy is also required to prevent graft hepatitis, whichmay lead to subsequent graft loss. Although combinationtherapy using NA and hepatitis B immune globulin（HBIG） has been the regimen most widely adopted forover a decade, recent studies have demonstrated thatnewer NAs with low rates of resistance are effective inpreventing graft hepatitis even without the use of HBIG,achieving excellent long term outcome. For patientswithout pre-existing resistant mutations, monotherapywith a single NA has been shown to be effective. Forthose with resistant strains, a combination of nucleosideanalog and nucleotide analog should be used. To date,clinical trials using therapeutic vaccination have shownsuboptimal response, as CHB patients likely have animmune deficit against HBV epitopes. Future strategiesinclude targeting different sites of the hepatitis Breplication cycle and restoring the host immunityresponse to facilitate complete viral eradication.
