HBV and HCV Infection Prophylaxis in Liver Transplant Recipients

Liver transplantation is the treatment of choice for patients with liver cirrhosis caused by viruses (HCV, HBV, and HBV + HDV) in end-stage liver disease. However, liver transplantation is complicated by the risk of recurrent infection, which significantly affects the graft and patient survival, the main risk factor for the development of recurrent viral infection being the viral load at the time of transplant. The development of antiviral drugs and effective prophylactic regimens using hepatitis B immunoglobulins have significantly improved hepatitis B outcomes after liver transplantation. Hepatitis B virus (HBV) reinfection after liver transplantation (LT) may favor the recurrence of hepatocellular carcinoma (HCC), and combination therapy with hepatitis B immunoglobulin (HBIG) and nucleoside/nucleotide analog may reduce HBV recurrence after LT. In patients transplanted for HCV infection due to the availability of direct-acting antivirals, the survival of transplanted patients is comparable to that of transplants performed for alcoholic liver disease and even better than the survival evaluated in patients with hemochromatosis or hepatitis B infection. However, current approaches continue to be hampered by the extremely high cost of treatment and the emergence of drug-resistant viral mutations.