Sintusek P, Thanapirom K, Komolmit P, Poovorawan Y. Eliminating viral hepatitis in children after liver transplants: How to reach the goal by 2030. World J Gastroenterol 2022; 28(3): 290-309 [PMID: 35110951 DOI: 10.3748/wjg.v28.i3.290]
Corresponding Author of This Article
Yong Poovorawan, MD, Professor, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan District, Bangkok 10330, Thailand. yong.p@chula.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Frontier
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Palittiya Sintusek, The Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI) Research Unit, Chulalongkorn University, Bangkok 10330, Thailand
Palittiya Sintusek, Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
Kessarin Thanapirom, Piyawat Komolmit, Division of Gastroenterology, Department of Medicine, Liver Fibrosis and Cirrhosis Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Kessarin Thanapirom, Piyawat Komolmit, Center of Excellence in Liver Diseases, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
Yong Poovorawan, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Poovorawan Y substantially contributed to conception of the study and drafted the manuscript; Sintusek P and Thanapirom K wrote the manuscript; Poovorawan Y and Komolmit P made critical revisions related to the intellectual content of the manuscript; all authors read and approved the final version of the manuscript.
Supported byThe Center of Excellence in Clinical Virology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand and Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI) Research Unit, Department of Pediatrics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Chulalongkorn University, Bangkok 10330, Thailand.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Yong Poovorawan, MD, Professor, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan District, Bangkok 10330, Thailand. yong.p@chula.ac.th
Received: June 3, 2021 Peer-review started: June 3, 2021 First decision: July 27, 2021 Revised: August 12, 2021 Accepted: January 6, 2022 Article in press: January 6, 2022 Published online: January 21, 2022 Processing time: 223 Days and 20.2 Hours
Abstract
Viral hepatitis infections are a great burden in children who have received liver transplant. Hepatotropic viruses can cause liver inflammation that can develop into liver graft fibrosis and cirrhosis over the long term. Immunological reactions due to viral hepatitis infections are associated with or can mimic graft rejection, rendering the condition difficult to manage. Prevention strategies using vaccinations are agreeable to patients, safe, cost-effective and practical. Hence, strategies to eliminate viral hepatitis A and B focus mainly on immunization programmes for children who have received a liver transplant. Although a vaccine has been developed to prevent hepatitis C and E viruses, its use is not licensed worldwide. Consequently, eliminating hepatitis C and E viruses mainly involves early detection in children with suspected cases and effective treatment with antiviral therapy. Good hygiene and sanitation are also important to prevent hepatitis A and E infections. Donor blood products and liver grafts should be screened for hepatitis B, C and E in children who are undergoing liver transplantation. Future research on early detection of viral hepatitis infections should include molecular techniques for detecting hepatitis B and E. Moreover, novel antiviral drugs for eradicating viral hepatitis that are highly effective and safe are needed for children who have undergone liver transplantation.
Core Tip: Viral hepatitis infections are a great burden for pediatric liver transplant recipients. Strategies to prevent infection include immunization, good sanitation and screening donor blood products and liver grafts for hepatitis B, C and E. In children infected with viral hepatitis who have received a liver transplant, early detection is crucial to guide proper management, as the infection can mimic or cause graft rejection. Effective antiviral therapy should be initiated when treating children with hepatitis B and C. Patients infected with hepatitis B who have undergone successful viral eradication should be revaccinated to maintain high hepatitis B surface antibodies to guarantee immunoprotection.
