Prophylaxis and posttransplant treatment of viral hepatitis in living-donor liver transplantation

Reinfection with hepatitis B virus (HBV) after liver transplantation (IT) causes both severe hepatitis and fibrosing cholestatic hepatitis (FSH) as early events, or liver cirrhosis within 5 years as a late event. Reinfection with hepatitis C virus (HCV) may not involve harmful events, but the majority of recipients develop chronic hepatitis and are at risk of hepatocellular carcinoma. As prophylaxis for HBV, living-donor liver transplantation (LDLT) is designed to allow the administration of lamivudine for a period of about 2-3 months before LT. The administration of lamivudine should be continued after IT with hepatitis B immunoglobulin being maintained at over 500 IU/ml. A prophylaxis for HCV has not yet been established. With cadaveric IT, we use both interferon and ribavirin for HCV, but it is not known for how long these drugs need to be administered before an adequate donor is available. Major complications are thrombocytopenia and hemolytic anemia. In our experience of the treatment of chronic hepatitis type C, the serum level of HCV-RNA decreases immediately after the administration of interferon-a and -beta. Therefore, it is recommended that interferon-P be administered for 1-2 weeks before LDLT to obtain seronegative HCV-RNA.