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The progress in treatment against hepatitis B virus has substantially improved the outcome of all hepatitis B-infected patients.
Dr George Papatheodoridis and colleagues from Greece systematically reviewed the existing data in the management of hepatitis B transplant patients in order to assess the optimal regimen in the pretransplant setting, for post-transplant prophylaxis and for therapy of hepatitis B recurrent infection.
All data suggest that an effective pretransplant anti-hepatitis therapy prevents post-transplant hepatitis B recurrence.
Pretransplant therapy has been based on lamivudine with addition of adefovir upon lamivudine resistance, but the use of newer, potent high-genetic barrier agents is expected to improve long-term efficacy.
It may lead to improvement of liver function, which sometimes removes the need for transplantation, although more objective criteria for removal from waiting lists are required.
After liver transplantation, the team found that the combination of hepatitis B immunoglobulin and one nucleotide analogue, mostly lamivudine, is currently the best approach, almost eliminating the probability of hepatitis B recurrence.
The research team noted that treatment of post-transplant hepatitis B recurrence has been mainly studied with lamivudine, but it will be most effective with entecavir and tenofovir, which have a low risk of resistance.
Dr Papatheodoridis' team commented, "The newer anti-hepatitis B agents improve the treatment of hepatitis B both pretransplant and post-transplant."
"Hepatitis B immunoglobulin is still used in combination with an anti-hepatitis B agent for post-transplant prophylaxis."
"Monoprophylaxis with one of the new anti-hepatitis B agents might be possible, particularly in patients preselected as having a low risk of hepatitis B recurrence, but further data are needed and strategies to ensure compliance must be used."
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