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Liver Transplantation Interdisciplinary Conference (2)
Digestive and Liver Disease Supplements 3 (2009) 74
www.elsevier.com/locate/dld
Preface
Liver Transplantation Interdisciplinary Conference (2) Liver transplantation has become “standard therapy” for terminal liver disease. Though transplantation is now successfully established throughout the world, there are still unresolved and unfinished problems, both in the technical performance and in the outcome related to etiology; viral etiology, in particular, is aggravated by a risk of infection recurrence. The latter remains a formidable problem in hepatitis C but is an almost resolved issue in hepatitis B thanks to adequate prevention; nevertheless optimisation of HBV prophylaxis is not satisfactory. This Interdisciplinary Liver Transplantation Conference gathered Italian and Spanish Centers to confront on the hottest topics related to the indications and surgical procedures. Issues such as non heart beating donor, split and living donors, transplant benefit in hepatocarcinoma and the pool expansion of organ procurement to reduce waiting lists were discussed. A major issue was how to enforce the best and most cost-effective prevention of hepatitis B recurrence focusing on the central role of hepatitis B immunoglobulins (HBIG). Experiences of HBIG discontinuation were debated, evaluating non convincing results after HBIG withdrawal with the near-to-zero rate of recurrence achieved by HBIG prophylaxis combined with antiviral drugs. A major issue was how the use of antivirals and the improvement of the patients’ virological conditions at liver transplantation are leading to reduction of HBIG dosages, which render intramuscular HBIG prophylaxis in the maintenance phase a feasible option with the same efficacy, reduced patient
hospitalization and lower costs compared to the intravenous administration. Important topics discussed were the optimization of the donor–recipient match and the role of HBIG in the prevention of de-novo HBV infections after liver transplantation, particularly in patients never exposed to the virus who receive a graft from an HBsAg-positive or an anti-HBc-positive donor; these situations are likely to occur increasingly, in the logic of expanding the number of transplants. Another area of current development is the use of HBIG in recipients of bone marrow transplantation from donors exposed to HBV, especially in those undergoing aggressive chemotherapy, in whom antivirals may have a myelosuppressive effect. During the conference a new technology for producing hepatitis B intravenous immunoglobulin (Niuliva® ) was presented; Niuliva maximizes purity, increasing the anti-HBs concentration up to 5 times that of traditional technologies; it also improves safety by pasteurization, a viral inactivation process which is able to inactivate the whole range of blood transmissible viruses in liquid protein solutions.
© 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Prof. Mario Rizzetto S.C. Gastro-Epatologia D.U. Azienda Ospedaliera Universitaria San Giovanni Battista di Torino Torino, Italy
www.elsevier.com/locate/dld
Preface
Liver Transplantation Interdisciplinary Conference (2) Liver transplantation has become “standard therapy” for terminal liver disease. Though transplantation is now successfully established throughout the world, there are still unresolved and unfinished problems, both in the technical performance and in the outcome related to etiology; viral etiology, in particular, is aggravated by a risk of infection recurrence. The latter remains a formidable problem in hepatitis C but is an almost resolved issue in hepatitis B thanks to adequate prevention; nevertheless optimisation of HBV prophylaxis is not satisfactory. This Interdisciplinary Liver Transplantation Conference gathered Italian and Spanish Centers to confront on the hottest topics related to the indications and surgical procedures. Issues such as non heart beating donor, split and living donors, transplant benefit in hepatocarcinoma and the pool expansion of organ procurement to reduce waiting lists were discussed. A major issue was how to enforce the best and most cost-effective prevention of hepatitis B recurrence focusing on the central role of hepatitis B immunoglobulins (HBIG). Experiences of HBIG discontinuation were debated, evaluating non convincing results after HBIG withdrawal with the near-to-zero rate of recurrence achieved by HBIG prophylaxis combined with antiviral drugs. A major issue was how the use of antivirals and the improvement of the patients’ virological conditions at liver transplantation are leading to reduction of HBIG dosages, which render intramuscular HBIG prophylaxis in the maintenance phase a feasible option with the same efficacy, reduced patient
hospitalization and lower costs compared to the intravenous administration. Important topics discussed were the optimization of the donor–recipient match and the role of HBIG in the prevention of de-novo HBV infections after liver transplantation, particularly in patients never exposed to the virus who receive a graft from an HBsAg-positive or an anti-HBc-positive donor; these situations are likely to occur increasingly, in the logic of expanding the number of transplants. Another area of current development is the use of HBIG in recipients of bone marrow transplantation from donors exposed to HBV, especially in those undergoing aggressive chemotherapy, in whom antivirals may have a myelosuppressive effect. During the conference a new technology for producing hepatitis B intravenous immunoglobulin (Niuliva® ) was presented; Niuliva maximizes purity, increasing the anti-HBs concentration up to 5 times that of traditional technologies; it also improves safety by pasteurization, a viral inactivation process which is able to inactivate the whole range of blood transmissible viruses in liquid protein solutions.
© 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Prof. Mario Rizzetto S.C. Gastro-Epatologia D.U. Azienda Ospedaliera Universitaria San Giovanni Battista di Torino Torino, Italy