PubMed · 11307528
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N Hayashi. 2001-03-10. [Chronic viral liver dysfunction].. https://pubmed.ncbi.nlm.nih.gov/11307528/
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In the absence of preventative therapy, deceased-donor liver transplantation indicated for hepatitis B virus (HBV) cirrhosis results in dismal graft and patient survival due to HBV infection of the liver graft. Major advances in the management of HBV-infected recipients during the past 15 years have reduced the rate of graft infection, resulting in improved outcomes, comparable to those for patients transplanted for non-HBV indications. Long-term use of hepatitis B immunoglobulin for passive immunotherapy is effective in preventing re-infection. Combination therapy with hepatitis B immunoglobulin and lamivudine after liver transplantation reduces HBV recurrence. Adefovir dipoxil is a safe and effective alternative oral antiviral treatment for lamivudine-resistant mutant HBV. The high cost of hepatitis B immunoglobulin remains a problem that must be overcome by the development of HBV vaccines and potent adjuvants.
The development of nucleic acid assays is of critical clinical importance for the diagnosis of viral hepatitis and the management of antiviral therapy. For both chronic hepatitis B and C, sensitive and quantitative assays are required for the monitoring of viral load. Better assays are being developed and their role in the management of antiviral treatment has been clearly demonstrated. Genotyping assays are critical for the decision of treatment strategies in hepatitis C, although in hepatitis B this issue is more debated. The detection of viral genome mutations for the diagnosis of hepatitis B virus resistance is critical with the use of nucleoside analogs. This may also prove useful for anti-hepatitis C virus therapy with the rapid development of specific inhibitors that may select for drug-resistant mutants.
Physicians involved in the management of patients with chronic hepatitis B infection are frequently faced with complex clinical issues concerning the diagnosis, investigation, and treatment of patients. Guidelines exist within the literature that help with decision making; however, in practice individual nuances are often encountered necessitating decisions that go beyond the current guidelines. Following presentation of the available data, a panel of expert hepatologists and gastroenterologists sought to identify and solve challenges that are faced by clinicians in the daily management of patients with chronic hepatitis B infection. The following summary provides an overview of the outcome of these discussions. Because of the complexities of clinical management, the recommendations reflect the opinion of the majority; however, many recommendations were not unanimous. Furthermore, the recommendations that follow are limited to adult patients; the treatment of children was not discussed. A number of issues were identified, and statements concerning possible management strategies that could be applied were developed.