A better understanding of the mechanism of viral replication and of viral transmission has led to improved results with OLTx for patients with
end-stage liver disease caused by viral
hepatitis. Patients with
hepatitis-B-related
liver disease who are HBV-
DNA negative can expect excellent survival after OLTx with long-term
HBIG therapy. Patients coinfected with HDV who are HBV-
DNA negative can also expect an excellent rate of survival. HBV-
DNA-positive patients may benefit from the addition of
lamivudine to the prophylactic regimen both before and after OLTx. De novo HBV
infections generally have a very benign course.
Lamivudine has proven to be very effective in the treatment of both de novo and recurrent HBV
infection after OLTx; however, resistance can develop. Allografts from donors with
antibodies to HBV can be used most effectively when directed to recipients who also harbor HBV
antibodies. The recurrence of HCV
infection after OLTx is universal; however, the 5-year survival rate in patients who received OLTx for HCV-related
liver disease is not diminished. Although a few patients experience an aggressive recurrence of HCV
infection after OLTx, prognostic indicators have not been determined to allow for identification of these patients.
Alpha-interferon does not seem to be effective in the treatment of recurrent HCV
infection after OLTx. Trials with combination
alpha-interferon-
ribavirin are underway. Retransplantation for HCV-related allograft failure can be performed safely in patients if performed before the onset of other organ system failure. Finally, anti-HCV-positive recipients of allografts from anti-HCV-positive donors have an excellent 5-year survival rate.