In western countries, approximately 10-25% of patients undergoing liver transplantation (LT) are hepatitis B surface antigen (HBsAg) carriers. In Asia, hepatitis B virus-related liver disease is the leading indication for LT. After surgery, hepatitis B can develop in these patients, the outcome of which depends largely on the prevention of hepatitis B recurrence.
In HBsAg-positive recipients, the spontaneous risk for hepatitis B after LT is up to 70% if no prophylaxis is administered. Major advances in prophylaxis during the last 15 years have allowed achievement of very good control of post-LT hepatitis B. From the beginning of the prophylaxis era, hepatitis B immunoglobulin (HBIG) played a pivotal role, either as monotherapy or in combination with antiviral drugs. In recent years, prophylaxis using antivirals with or without HBIG has been proposed.
The analysis of the recent literature on this situation shows that HBIG maintains a significant role in the control of hepatitis B recurrence following LT in patients originally HBsAg-positive. The outcomes of antiviral therapy with or without HBIG remain controversial.