Prevention and Management of HBV in Organ Transplantation
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HEPATITIS B (JK LIM, SECTION EDITOR)
Prevention and Management of HBV in Organ Transplantation Stela Celaj 1 & Josh Levitsky 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Hepatitis B (HBV) infection and reactivation have a significant impact on solid organ transplantation. This review summarizes past significant studies and new findings in the field, and presents the latest recommendations for HBV management in solid organ transplant population. Recent Findings Significant advances in antiviral therapy have resulted in improved graft outcomes and have notably reduced the need for prophylaxis with hepatitis B immunoglobin. Emerging treatment avenues such as immunotherapies and small molecules inhibitors are being developed with the intent of eradicating HBV infection. Summary Substantial suppression of HBV is obtained with the current antiviral prophylaxis in transplant patients. This has allowed for safely expanding the donor pool to HBcAb-positive grafts with good outcomes. Novel therapies are showing a promising future for achieving functional cure for HBV. Keywords Hepatitis B prophylaxis . Transplantation . Hepatitis B recurrence . Functional cure
Introduction Hepatitis B (HBV) is widely prevalent with approximately 257 million people chronically infected worldwide [1, 2]. Chronic HBV (CHB) can cause progressive fibrosis and cirrhosis, leading to liver cancer. In the USA, it is estimated that 2.2 million people are infected with HBV, of which 15–25% develop cirrhosis or hepatocellular carcinoma (HCC) [3]. This number may underestimate the immigrant communities living in the USA, where HBV prevalence is much higher [4]. Liver transplant (LT) is currently the gold standard for HBV-related liver failure. Despite the breakthroughs in viral suppressive therapy and immunization, HBV reactivation and transmission following liver and other solid organ This article is part of the Topical Collection on Hepatitis B * Josh Levitsky [email protected] 1
Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
2
Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., 19th Floor, Chicago, IL 60611, USA
transplantation remains a relevant clinical issue. Therefore, this review will focus on the diagnosis, prevention, and management of HBV in solid organ transplantation. In addition, ongoing research and new treatment avenues for HBV will be discussed.
Diagnosis Hepatitis B is a dsDNA virus that is transmitted parenterally, sexually, and perinatally. The virus is a member of the Hepadnaviridae family that infects hepatocytes by covalently closed circular DNA (cccDNA) [5]. Serologic and DNA testing together help distinguish between vaccination, exposure, and active hepatitis B infection. In addition, nucleic acid testing aids in decreasing the window period of acute HBV infection from 44 to 22 days [6]. According to the
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