Management of hepatitis B and C post transplantation

Ganesalingam Kanagasabai

Clinical evidence is limited and is often an extrapolation  of evidence obtained from non transplant population.  The progression of liver disease due to viral hepatitis B  or C  is more rapid after organ transplantation. %.  A liver biopsy is useful in making decisions . Aminotransferases in patients with chronic renal failure and viral hepatitis B or C are typically depressed.

Hepatitis C has an adverse effect on patient and graft survival in renal transplant recipients.  Treatment of hepatitis C after renal transplantation with interferon   has a high frequency  of acute impairment of allograft function  which is often not reversible with pulse methylprednisolone therapy resulting in return to dialysis.
It is therefore important to try and treat the hepatitis C  before the renal transplant.  The sustained virological response with 1 year standard interferon in patients on hemodialysis with hepatitis C is around 37

Hepatitis  C recurs almost universally following a liver transplant.  There is increased HCV related fibrosis progression and impaired survival.  Treatment of hepatitis C after a liver transplant is disappointing. Hepatitis C in heart transplant recipients results in accelerated allograft  vasculopathy

The prevalence of hepatitis B in dialysis patients  is declining due to   effective vaccines, good infection control, regular surveillance and patient isolation.  Patients with hepatitis B going for a  renal transplant may benefit from lamivudine post transplant with better survival and lower liver related mortality. 

Hepatitis B recurs  after liver transplant. Suppression of hepatitis B virus prior to liver transplant is an important goal.  Treatment of hepatitis B post liver transplant includes hepatitis B immunoglobulin, lamivudine and /or adefovir.