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HBV Prophylaxis Post-Liver Transplant — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV Prophylaxis Post-Liver TransplantSCE Infectious Diseases

A 45-year-old man with known chronic hepatitis B develops hepatocellular carcinoma. He is HBsAg positive and on Entecavir with undetectable HBV DNA. His tumour is within Milan criteria (single lesion <5 cm). He is assessed for liver transplant. What specific HBV-related consideration applies to the transplant assessment?

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Correct answer: A — Post-transplant HBV prophylaxis (HBIG ± NUC) will be required lifelong to prevent HBV recurrence in the graft — this must be factored into the transplant plan

Liver transplant for HBV-related HCC requires lifelong post-transplant HBV prophylaxis to prevent recurrence in the new graft. The standard approach is HBIG (hepatitis B immunoglobulin) combined with a nucleos(t)ide analogue (Entecavir or Tenofovir). Without prophylaxis, HBV recurrence rates in the graft exceed 80%. Some modern protocols use NUC monotherapy after initial HBIG, as HBV recurrence rates are very low with high-barrier NUCs. This must be part of the transplant consent and long-term care plan.

Reference: EASL 2024 – HBV; NICE NG37 2016 – Liver transplant