ScienceTherapeutic Focus Areas

Hepatitis B recurrence after liver transplantation

Hepatitis B is a liver infection caused by the hepatitis B virus. It is a major global health problem.

Some people with hepatitis B are sick for only a few weeks (known as an “acute” infection). Some people, especially those who get infected in adulthood, can clear the virus from their bodies without treatment. Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95% of cases.  Over time, chronic hepatitis B can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.

WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections yearly.

In 2019, hepatitis B resulted in an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).

HBV can be acquired by:

  • Direct blood-to-blood contact
    • Mother to child during birth
    • Household contact
    • Unsterile healthcare practices
    • Sharing needles
  • Sexual transmission

Most people do not experience any symptoms when newly infected. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting, and abdominal pain. In addition, people with acute hepatitis can develop acute liver failure, leading to death.

A safe and effective vaccine that offers 98% to 100% protection against hepatitis B is available.

HBV recurrence rates in HBV-related liver transplant patients are relatively low (5-10%) in countries with high vaccination rates. However, in countries with low vaccination rates, recurrence can occur in 30% of liver transplant patients.

Several important liver societies worldwide, like AASLD and EASL, provide guidelines for preventing HBV recurrence after HBV-related liver transplants. They all recommend combination therapy with Hepatitis B immunoglobulins, like HepaGam B, and an antiviral.