JLE

Hépato-Gastro & Oncologie Digestive

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Therapeutic strategies in patients with decompensated cirrhosis and liver transplant patients Volume 14, supplement 5, Numéro spécial : Prise en charge de l’hépatite chronique B en 2007

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Authors
Centre Hépatobiliaire, Hôpital Paul Brousse, 14 avenue Paul Vaillant Couturier, 94800 Villejuif, France, Inserm U785, Université Paris Sud UMR-S785

The availability of highly effective antiviral agents against HBV such as lamivudine, adefovir, entecavir, tenofovir … improved the outcome of patients with decompensated cirrhosis awaiting transplantation but is limited by the development of viral resistance. Long-term prognosis of liver transplantation for HBV disease depends on the prevention of allograft reinfection or the slowing of disease progression in those who have recurrent disease. Failure of prophylaxis with all the therapies to date is more frequent in those with high levels of HBV DNA pretransplantation. The use of long-term HBV immune globulin (HBIG) or antiviral monoprophylaxis are much effective to prevent reinfection in patients without active viral replication. The use of HBIG in combination with antivirals reduce the risk of reinfection to 10 % even in patients with active viral replication. Patients without active viral replication are eligible for protocols using shorter-term HBIG or vaccination in combination with continued antiviral therapy. The availability of effective antivirals accounts also for the substantial gains made in the past decade in the treatment of recurrent HBV graft infection.