Current therapeutic strategies for recurrent hepatitis B virus infection after liver transplantation

Hepatitis B virus (HBV)-related liver disease is the leading indication for liver transplantation (LT) in Asia,especially in China.With the introduction of hepatitis B immunoglobulin (HBIG) and oral antiviral drugs,the recurrent HBV infection rate after LT has been evidently reduced.However,complete eradication of recurrent HBV infection after LT is almost impossible.Recurrent graft infection may lead to rapid disease progression and is a frequent cause of death within the fi rst year after LT.At present,the availability of new oral medications,especially nucleoside or nucleotide analogues such as adefovir dipivoxil,entecavir and tenofovir disoproxil fumarate,further strengthens our ability to treat recurrent HBV infection after LT.Moreover,since combined treatment with HBIG and antiviral agents after liver re-transplantation may play an important role in improving the prognosis of recurrent HBV infection,irreversible graft dysfunction secondary to recurrent HBV infection in spite of oral medications should no longer be considered an absolute contraindication for liver re-transplantation.Published reviews focusing on the therapeutic strategies for recurrent HBV infection after LT are very limited.In this article,the current therapeutic strategies for recurrent HBV infection after LT and evolving new trends are reviewed to guide clinical doctors to choose an optimal treatment plan in different clinical settings.

Clinical experience in liver transplantation from an organ transplantation center in China

Objective: To sum up the experience in liver trans- plantation in a period of ten years at a single center. Methods: We retrospectively reviewed the clinical re- cords of 120 patients receiving liver transplantation from April 1993 to October 2002. The patients' cli- nical characteristics, surgical techniques, complica- tions and survival were compared in the phases of 1993-1997 (phase Ⅰ), 1999 (phase Ⅱ), and 2000- 2002 (phase Ⅲ). Results: Malignant liver diseases were major indica- tions for liver transplantation in phase Ⅰ(100%) and Ⅱ(53. 3%), but decreased markedly in percentage in phase Ⅲ(34. 0%). When compared with recipi- ents in phase Ⅰ and Ⅱ, the survival of recipients with benign liver diseases in phase Ⅲ was significantly im- proved with the 3-month, 6-month and 1-year sur- vival rates of 85. 7%, 84. 5% and 83. 1%, respec- tively. For patients with malignant liver diseases, the 3-month, 6-month and 1-year survival rates were 87. 4%, 81. 1% and 46. 0%, respectively. The rein- fection rate of hepatitis B virus was 24% 12 months after transplantation. With technical refinements, the incidence of postransplantation vascular compli- cations has significantly decreased from 29. 4% in phase Ⅰ and Ⅱ to 4. 9% in phase Ⅲ. Biliary compli- cations remained one of the major obstacles to long- term survival. No reno-venous bypass was applied in phase Ⅲ, providing a promising outcome. Conclusion: Strict selection of potential recipients, technical refinement, appropriate management of vascular and biliary complications, and prophylaxis of recurrences of hepatitis B and malignant liver dis- eases are important to obtain long-term survival of patients receiving liver transplantation in China.