Liver transplantation for chronic viral hepatitis B and C / 中华肝胆外科杂志

ABSTRACT

Liver transplantation is considered an effective form of therapy for patients with end-stage liver disease.Unfortunately the results of transplantation for patients with chronic viral hepatitis have not been as promising as for other liver disorders.A high rate of hepatitis recurrence in the allograft leading to a higher incidence of graft and patient loss have led many transplant centers to reconsider the use of orthotopic liver transplantation(OLTX)in these groups.Current strategies to prevent hepatitis B infection focus on identifying groups of hepatitis B virus(HBV)patients with lower risks of reinfection,specifically those with lack of markers for active HBV replication.Trials to convert"high risk"HBV patients to a "low risk"group have recently been initiated in the "high risk"group of patients with the aim to convert their HBV status from replicating to nonor low-replicating states.Antiviral agents or immunostimulatory therapy before and/or after OLTX have been proposed as a means to minimize recurrence of hepatitis B in the liver allograft.While the focus has been specific issues related to prevention or treatment of viral hepatitis in OLTX patients,there are still a number of areas for investigation.For example,immunosuppression is considered to play a role in the recurrence and chronicity of HBV and hepatitis C virus(HCV)in the liver allograft,especially since corticosteroids have been demonstrated to have a biologic effect on HBV by inducing HBV antigen synthesis.Moreover,most of the results to date are based on the use of cyclosporin A as the primary agent of immunosuppression.Tacrolimus(FK506)based immunosuppression may also prove to have a beneficial effect for HBV patients undergoing OLTX.By minimizing or eliminating the need for corticosteroids,FK560 based immunosuppression may lessen the risk of recurrence or the severity of hepatitis in the liver allograft in HBV patients,and ultimately improve patient and graft survival.The controversies in the use of OLTX for HBV and HCV have persisted,in spite of an appreciation for the risks associated with selection,prophylaxis and treatment of candidates with HBV,principally dut to the uncertainties associated with OLTX for HCV.The routine application of OLTX to HBV candidates with low or no levels of HBV replication appears justified,however patients with active HBV replication should undergo OLTX only in a setting where new strategies for prevention, prophylaxis or treatment are being tested.Recently,the U.S.Department of Health and Human Services has approved OLTX for HBV,reflecting the improvements made in the clinical arena.However,further advances are needed for HCV prophylaxis and treatment of recurrent hepatitis following OLTX.