Μanagement of patients with hepatitis B and C before and after liver and kidney transplantation

Table 1 Recommendations for the management of hepatitis B and C infection before and after liver or renal transplantation

	Chronic hepatitis B		Chronic hepatitis C
	Liver transplantation	Kidney transplantation	Liver transplantation	Kidney transplantation
Pre transplant	NAs1		Peg IFN ± RBV ± DAAs3 (depending on genotype and type of DAA)	PegIFN plus very low dose RBV (plus DAAs)4
Post transplant	Prophylaxis and treatment		No prophylaxis2
	Short term HBIG plus NA	NAs1	Peg IFN ± RBV ± DAAs3 (depending on genotype and type of DAA)	Peg IFN plus very low dose RBV

¹Entecavir or tenofovir are the advisable NAs in adjusted doses regarding creatinine clearance;

²Therapy is indicated in fulminant cholestatic hepatitis and de novo glomerulonephritis;

³Records for boceprevir, telaprevir and sofosbuvir. Τriple combination is preferable in cases of cirrhosis (METAVIR fibrosis stages 3 and 4), cholestatic hepatitis, previous virological failure and in the presence of predictors of poor response;

⁴There are only cases for the use of DAAs in renal transplant candidates. HBV: Hepatitis B virus; HCV: Hepatitis C virus; NA: Nucleos(t)ide analog; HBIG: Hepatitis virus immunoglobulin; DAAs: Direct oral acting antivirals; Peg IFN: Peg interferon; RBV: Ribavirin.

Table 2 Safety and efficacy of the combined regimen, interferon, ribavirin and protease inhibitors to treat hepatitis C after liver transplantation

	Boceprevir (n)	Telaprevir (n)	Complete virological response	Side effects
Coilly et al[72]	18	19	58% TVR	Anemia 92%
			89% BOC	Infections 27%
				Fatal events 8%
Pungpapong et al[73]	31	35	86% TVR	Anemia 95%
			48%BOC	Infections 10%
				Renal dysfunction 76%
				Fatal events 3%
Werner et al[74]	-	9	88.80%	Anemia 75%
				Rash 33%
				Renal dysfunction 33%
Stravitz et al[75]		50	62%	Anemia 82%
				Renal failure
				Fatal events 7%
Ann Brown et al[76]	-	46	60%	Anemia 48%
				Rash 35%
				Pruritus 22%
				Renal failure 22%
				Infections 22%
				Anorectal symptoms 41%
Forns et al[77]	Sofosbuvir 115		78%	Fatal events 16%

BOC: Boceprevir; TVR: Telaprevir.

Table 3 Prophylactic schemes against hepatitis B virus recurrence after liver and renal transplantation when grafts are from hepatitis B virus positive donors

	Donor	Recipient	Prophylaxis
Liver transplantation	Anti-HBc positive	HBsAg positive	HBIG plus NA
		HBsAg negative	No prophylaxis
		Anti-HBc positive
		Anti-HBs positive
		Anti-HBc negative	Long term lamivudine
		Anti-HBs negative
	HBsAg positive	Anti-HBc positive	HBIG plus NA
Kidney transplantation	Anti-HBc positive	HBsAg negative	No prophylaxis
			Treatment when HBV DNA increases
	HBsAg positive	HBsAg positive	HBIG plus lamivudine
	(HBV DNA negative)	HBsAg negative	Long term lamivudine
		(HBV DNA) negative

HBV: Hepatitis B virus; NA: Nucleos(t)ide analog; HBIG: Hepatitis virus immunoglobulin.