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HBV Post-Transplant Management — ESENeph MCQ

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ModerateTransplantationHBV Post-Transplant ManagementESENeph

A 55-year-old man on haemodialysis has chronic hepatitis B (HBsAg+, HBV DNA suppressed on Entecavir). He receives a deceased donor kidney transplant. Post-transplant, what is the management of his hepatitis B?

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Correct answer: D — Continue Entecavir indefinitely – risk of HBV reactivation with immunosuppression

Post-transplant, HBV reactivation risk is significantly increased due to immunosuppression. Antiviral therapy (Entecavir or TAF) must be continued indefinitely. Interferon is contraindicated post-transplant (risk of rejection). Regular monitoring of HBV DNA and liver function is essential. If the donor was HBsAg+ (hepatitis B-positive donor), additional considerations apply. Core-positive donors (anti-HBc+/HBsAg-) require prophylaxis in the recipient.

Reference: KDIGO 2009 – Transplant Guideline; EASL 2024 – HBV Guidelines