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Int. J. Mol. Sci. 2015, 16(8), 17494-17513; doi:10.3390/ijms160817494

Molecular Mechanisms to Control Post-Transplantation Hepatitis B Recurrence

1
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
2
Department of Gastroenterological Surgery Transplant and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
*
Author to whom correspondence should be addressed.
Academic Editor: Tatsuo Kanda
Received: 24 May 2015 / Revised: 25 July 2015 / Accepted: 27 July 2015 / Published: 30 July 2015
(This article belongs to the Special Issue Viral Hepatitis Research)
View Full-Text   |   Download PDF [918 KB, uploaded 30 July 2015]   |  

Abstract

Hepatitis B often progresses to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT). Although newer nucleos(t)ide analogues result in >90% viral and hepatitis activity control, severely decompensated patients still need OLT because of drug-resistant virus, acute exacerbation, or hepatocellular carcinoma. Acute hepatitis B is also an indication for OLT, because it can progress to fatal acute liver failure. After OLT, the hepatitis B recurrence rate is >80% without prevention, while >90% of transplant recipients are clinically controlled with combined hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogue treatment. However, long-term HBIG administration is associated with several unresolved issues, including limited availability and extremely high cost; therefore, several treatment protocols with low-dose HBIG, combined with nucleos(t)ide analogues, have been investigated. Another approach is to induce self-producing anti-hepatitis B virus (HBV) antibodies using an HBV envelope (HBs) antigen vaccine. Patients who are not HBV carriers, such as those with acutely infected liver failure, are good candidates for vaccination. For chronic HBV carrier liver cirrhosis patients, a successful vaccine response can only be achieved in selected patients, such as those treated with experimentally reduced immunosuppression protocols. The present protocol for post-OLT HBV control and the future prospects of newer treatment strategies are reviewed. View Full-Text
Keywords: acute hepatitis B; liver cirrhosis; hepatitis B virus vaccine; liver transplantation; hepatitis B immunoglobulin; nucleos(t)ide analogue acute hepatitis B; liver cirrhosis; hepatitis B virus vaccine; liver transplantation; hepatitis B immunoglobulin; nucleos(t)ide analogue
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Takaki, A.; Yasunaka, T.; Yagi, T. Molecular Mechanisms to Control Post-Transplantation Hepatitis B Recurrence. Int. J. Mol. Sci. 2015, 16, 17494-17513.

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