Abstract
Liver transplantation is the only therapy for patients with end-stage liver disease,
hepatocellular carcinoma, or fulminant hepatitis due to hepatitis D virus (HDV) and
hepatitis B virus (HBV) coinfection or superinfection. Patients chronically coinfected
with HDV are less at risk of HBV recurrence and have a better survival rate than patients
infected with HBV alone. Patients coinfected with HDV generally do not require pretransplant
antiviral therapy. Rates of recurrent HBV-HDV infection are lower than 5% using low-dose
intramuscular (IM) HBIg and antiviral prophylaxis in combination. Few studies have
evaluated the possibility of using shorter-term HBIg (12–24 months) then switching
to antiviral therapy. Although HBV replication can be controlled by potent HBV-polymerase
inhibitors, reappearance of HBsAg and/or the persistence of HBV DNA in serum, liver,
or peripheral blood mononuclear cells might have deleterious consequences in the setting
of HBV-HDV coinfection as they may provide the biologic substrate to the reactivation
of HDV. No effective antiviral drug is available for the treatment of graft infection
with HDV.
Keywords
Hepatitis Delta liver transplantation - Hepatitis B immune globulins - HBV antiviral
drugs
