Changes in the relationship between hepatitis B virus and liver transplantation in the last decades

Year 2019, , 396 - 404, 30.09.2019

Akif Altınbas , Bernd Kronenberger Ali Canbay

https://doi.org/10.18663/tjcl.590478

Abstract

In the last decade, both hepatitis B virus (HBV)
prevalence and mortality related to HBV infection have decreased promptly.
Worldwide HBV vaccination programs, precautions against HBV transmission and
effective anti-viral drugs on market play crucial role for this encouraging
result. Besides stopping or reversing the hepato-fibrogenesis induced by HBV
infection, fighting against HBV related acute severe hepatitis are also
improved recently. HBV associated cirrhosis is still the major cause of
LTx, particularly in developing countries,whereas in developed countries, the
rate of LTx due to HBV induced cirrhosis has declined over time. With the
expanding use of NUCs before LTx, and the use of NUCs and HBIg even after LTx,
HBV recurrence after LTx is no longer an important reason for graft loss or
patient death. However, this positive impact is not yet reflecting survival,
probably because of increasing recipient and donor ages. On the other hand, in
the era of Milan criteria, overall hepatocellular carcinoma (HCC) survival has
so increased that the number of transplanted HCC cases has almost doubled.
However tumor recurrence is still the major cause of death, and treatment is
still problematic.

Keywords

hepatitis B virus, acute or chronic infection, cirrhosis, hepatocellular carcinoma, liver transplantation, vaccine

Hepatit B virus enfeksiyonu nedenli karaciğer nakillerde son yıllardaki değişim

Abstract

Hepatit B virus (HBV) enfeksiyonu prevelansındaki ve
HBV ilişkili mortalitesindeki azalma son yıllarda oldukça dikkat çekicidir. Dünya
çapında yaygın olarak uygulanan HBV aşı programları ve HBV’ye karşı kullanımda olan
anti-viral ilaçların etkinliği bu başarıda başat rol oynamaktadır. HBV ile mücadelede,
sadece HBV’ye bağlı karaciğer fibrozunun ilerlemesi veya geriye döndürülmesi değil,
aynı zamanda HBV ilişkili şiddetli akut hepatit tablosunun tedavisinde güzel sonuçlar
alınmaktadır. Gelişmekte olan ülkelerde HBV ilişkili siroz karaciğer nakli konusunda
halen esas sebep iken, gelişmiş ülkelerde zaman içinde HBV nedenli karaciğer nakil
sıklıkları ciddi oranda düşüş göstermiştir. Anti-viral ilaçların karaciğer nakli
öncesi etkin kullanımı, HBIg tedavisinin nakil sonrasında yaygın olarak kullanımı
sayesinde karaciğer nakli sonrası HBV nüksü, mortalite ve greft kaybı konusunda
eskisi kadar sorun olmaktan çıkmıştır. Bu başarının nakil sonrası sürviler üzerine
bariz bir yansıması henüz olmamıştır. Buradaki esas sebep ise, alıcı ve verici yaşının
son yıllarda önemli oranda artış göstermesi olarak gösterilmektedir. Ekolarak,
Milan kriterlerinin yaygın olarak klinik pratiğe girmesiyle karaciğer nakli yapılan
hepatosellüler kanser (HCC) hasta sayısı da neredeyse ikiye katlamıştır. Ancak,
HCC rekürrensi, nakil sonrası en önemli ölüm nedeni olarak devam etmektedir.

Keywords

Hepatit B virus, akut ve kronik HBV enfeksiyonu, siroz, hepatosellüler kanser, karaciğer nakli, aşı

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