Management of viral hepatitis in liver transplant recipients

Recurrence of viral hepatitis after liver transplantation (LT) can progress to graft failure and lead to a decrease in long-term survival. Recently, there have been remarkable improvement in the treatment of chronic hepatitis B (CHB) using potent antiviral agents. Combination of hepatitis B immunoglobulin and potent antiviral therapy has brought marked advances in the management of CHB for liver transplant recipients. Post-transplant antiviral therapy for hepatitis C virus infection is generally reserved for patients showing progressive disease. Acheiving a sustained virological response in patients with LT greatly ameliorates graft and overall survival, however this only occurs in 30% of transplant recipient using pegylated interferon and ribavirin (RBV). Direct acting antivirals such as protease inhibitors, polymerase or other non-structural proteins inhibitors are anticipated to establish the new standard of care for transplant recipients. In liver transplant recipients, hepatitis E virus infection is an uncommon disease. However, it can lead to chronic hepatitis and cirrhosis and may require retransplantation. Recently, 3-month course of RBV monotherapy has been reported as an effective treatment. This review focuses on the recent management and therapeutic approaches of viral hepatitis in liver transplant recipient.

Hepatitis E in Pakistan

In Pakistan, sporadic cases of hepatitis E occur throughout the year. However, small outbreaks and epidemics of hepatitis E have been reported from the cities of Peshawar, Mardan, Abbottabad, Rawalpindi-Islamabad, Sargodha, Multan, Hyderabad, Quetta and Karachi. A large epidemic of hepatitis E occurred in one of the army garrisons at Lahore in early 1995, when more than 600 cases were treated as inpatients. Wherever epidemiological investigations have been carried out, the cause of the outbreak has always been found to be contamination of water supplies with sewage. This paper considers the epidemiology, diagnosis, clinical features, treatment, prevention and control of hepatitis E in Pakistan