Management of HBV resistance in the post-transplant setting

In western countries, about 10–25% of patients undergoing liver transplantation (LT) are HBsAg carriers. In Asia, HBV-related liver disease is the leading indication to LT. After surgery hepatitis B can develop in patients transplanted for HBV-related disease or in HBsAg-negative recipients of anti-HBc positive grafts. In the last years prophylaxis with HBIG and/or antivirals has been proposed in both conditions with excellent results. However, lack of efficacy of prophylaxis is frequently associated with the selection of HBV mutants resistant to the different drugs.