Liver Transplantation and Hepatitis B

In the United States, 5000 persons die each year of complications of hepatitis B virus (HBV) infection. Liver transplantation prolongs life and improves quality of life for patients with many types of chronic liver disease. It has also been used in patients with hepatitis B, many of whom are young and are otherwise good candidates for transplantation. Unfortunately, the early results of transplantation for patients with chronic hepatitis B were discouraging [1]. Survival was poor, and HBV reinfection of the liver graft often resulted in a rapidly progressive course of disease. In contrast, patients who underwent transplantation for hepatitis C have had outcomes similar to those of patients receiving liver transplants for other indications, despite the universal recurrence of hepatitis C virus infection.

Because of the initial poor results, some consider HBV infection to be a contraindication to transplantation [2], and Medicare does not include hepatitis B as a reimbursable indication for liver transplantation [3]. In 1994, the liver transplantations done for HBV infection accounted for only 3.2% of all liver transplantations done in adults in the United States [4]. This editorial addresses the controversial role of liver transplantation in HBV-infected patients and makes recommendations for the use of transplantation in patients with this often deadly disease.

When the physician and patient consider HBV infection an indication for liver transplantation, they need to ask several questions. First, what are the rates of recurrent disease and overall survival after transplantation for hepatitis B? Second, do some subgroups of patients with hepatitis B have more favorable outcomes? Third, is pretransplantation or post-transplantation therapy available that will prevent HBV infection in the hepatic allograft? Finally, if hepatitis B does recur, what are the outcomes associated with the various treatment strategies? The answers to these questions will allow us to …