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World J Gastroenterol. May 14, 2020; 26(18): 2166-2176
Published online May 14, 2020. doi: 10.3748/wjg.v26.i18.2166
Hepatitis B virus recurrence after liver transplantation: An old tale or a clear and present danger?
Ilaria Lenci, Martina Milana, Giuseppe Grassi, Tommaso M Manzia, Carlo Gazia, Giuseppe Tisone, Roberta Angelico, Leonardo Baiocchi
Ilaria Lenci, Martina Milana, Giuseppe Grassi, Leonardo Baiocchi, Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
Tommaso M Manzia, Carlo Gazia, Giuseppe Tisone, Roberta Angelico, Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
Author contributions: Lenci I made the analysis and interpretation, and drafted the manuscript; Lenci I, Milana M, Grassi G, Manzia TM, Gazia C, Tisone G, and Angelico R made the acquisition of data and critical revision; Baiocchi L made the proposal of study, study conception, correction of manuscript and critical revision.
Conflict-of-interest statement: No conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Leonardo Baiocchi, MD, PhD, Assistant Professor, Hepatology and Liver Transplant Unit, University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy. baiocchi@uniroma2.it
Received: February 11, 2020
Peer-review started: February 11, 2020
First decision: March 6, 2020
Revised: March 12, 2020
Accepted: April 30, 2020
Article in press: April 30, 2020
Published online: May 14, 2020
Processing time: 92 Days and 14 Hours
Abstract

Hepatitis B virus (HBV) recurrence after liver transplantation (LT) has been described more than 50 years ago. Similarly, to other clinical conditions, in which impairment of host immune defense favors viral replication, early reports described in details recurrence and reactivation of HBV in liver transplant recipients. The evidence of a possible, severe, clinical evolution of HBV reappearance in a significant percentage of these patients, allowed to consider, for some years, HBV positivity a contraindication for LT. Moving from the old to the new millennium this picture has changed dramatically. Several studies contributed to establish efficient prophylactic protocols for HBV recurrence and with the advent of more potent anti-viral drugs an increased control of infection was achieved in transplanted patients as well as in the general immune-competent HBV population. Success obtained in the last decade led some authors to the conclusion that HBV is now to consider just as a “mere nuisance”. However, with regard to HBV and LT, outstanding issues are still on the table: (1) A standard HBV prophylaxis protocol after transplant has not yet been clearly defined; (2) The evidence of HBV resistant strains to the most potent antiviral agents is claiming for a new generation of drugs; and (3) The possibility of prophylaxis withdrawal in some patients has been demonstrated, but reliable methods for their selection are still lacking. The evolution of LT for HBV is examined in detail in this review together with the description of the strategies adopted to prevent HBV recurrence and their pros and cons.

Keywords: Liver transplant; Hepatitis B virus; Viral recurrence; Prophylaxis; Minimization; Antiviral drug

Core tip: Liver transplantation for hepatitis B virus (HBV) has greatly evolved in the last 50 years. Several studies contributed to establish efficient prophylactic protocols for HBV recurrence and with the advent of more potent anti-viral drugs an increased control of infection was achieved. In this review we examined in detail the results obtained in preventing HBV reappearance in liver transplanted patients and the possible future directions of research in this field.