What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
What Do You Mean By A Hepatitis B Cure
The nature of the Hepatitis B virus is complex and can cause different kinds of infection. Thus, there are actually four levels of cure, each building on top of the last: level I partial cure, level II functional cure, level III complete cure and level IV sterilizing cure.
Answered by: Thomas Tu, Australia
Founder and Director, HepBCommunity.org President, Australian Centre for Hepatitis Virology Group Leader, Westmead Institute for Medical Research, University of Sydney, Australia
International Workshop On Hbv Cure 2021
Related Enduring Materials
Since 2014, the International Workshop on HBV Cure has been a scientific platform that acts as a catalyst to accelerate the progress for achieving a cure. Around the globe, more than 250 million people are chronically infected with hepatitis B . The purpose of the workshop was to inform the participants about the developments in the possibilities to find a cure for HBV. The meeting was highly interactive with input from experts out of the arena of basic, translational, and clinical HBV research.
The field of HBV treatment is undergoing major changes and is on the verge of a paradigm shift. The many new treatment options that are becoming available are providing great hopes for decreasing the burden of the disease, simplifying treatment, and potentially curing and eradicating HBV infection.
In order to optimize curative treatment for HBV, outstanding speakers from around the globe shared the newest therapeutic options for viral hepatitis, and experts will discuss the path forward to cure this deadly disease, leading to liver cirrhosis and liver cancer. Questions on which endpoints to use in therapeutic trials and how to combine different agents targeting the virus and/or immune system were extensively discussed.
This workshop also brought together global inter-disciplinary experts to provide a framework for how academia and industry should collaborate to achieve the goal of curing hepatitis B.
Program Chairs 2021
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Candidates In The General Population
Antiviral treatment is an effective therapeutic strategy for CHB patients that efficiently suppresses HBV replication, decreases inflammatory necrosis in the liver, reduces the incidence of liver cirrhosis and related complications, and reduces the fatality rate associated with hepatocellular carcinoma and other liver diseases. In the 2019 China guidelines , HBV infection is divided into four phases: immune tolerance, immune clearance, immune control, and immune reactivity, and it is different from the 2015 version . Additionally, the 2019 China guidelines eased the restrictions on indications for antiviral therapy, and reducing the demand for HBV-DNA load. Conversely, the HBV-DNA load is considered for the performance of antiviral therapy in the 2018 guidelines updated by the 2018 AASLD guideline and the 2017 EASL guidelines . For the treatment of HBV infection with normal ALT , antiviral therapy is recommended in patients > 30-years-old with a family history of liver cirrhosis or cancer in the 2019 China guidelines. In another case > 30-years-old without a family history of liver cirrhosis or cancer, a hepatic biopsy was recommended. Although we can refer to many guidelines, there are many patients failed to fulfill the criteria for treatment at follow-up and eventually developed liver fibrosis, cirrhosis, and cancer .
Table 1. Comparison between 2015 and 2019 guidelines.
Table 2. Indications for chronic hepatitis B treatment in 2017 and 2018 guidelines.
The Future Of Treatment
Chairman of the Scientific Advisory Council for the annual International Hepatitis B Virus Meeting and the Incoming Chair of the International Coalition to Eliminate HBV, Dr Tavis works on the front line of researching new developments in HBV treatments.
Dr Tavis says the cure to HBV is coming. The feeling within the scientific community is that major improvements will happen somewhere in the next five to 10 years it isnt going to be one optimal combination at first.
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Current Treatment Of Chronic Hepatitis B: Clinical Aspects And Future Directions
- 1The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Jinhua, China
- 2International Institutes of Medicine, Zhejiang University, Jinhua, China
Hepatitis B virus infection is a public health threat worldwide, and there is no direct treatment yet available. In the event of infection, patients may present liver cirrhosis and cancer, which threaten the patients health globally, especially in the Asia-Pacific region and China. In 2019, Chinese hepatopathologists updated the 2015 Guidelines for the Prevention and Treatment of Chronic Hepatitis B as the clinical reference. The other versions formulated by the American Association for the Study of Liver Diseases , European Association for the Study of the Liver , and Asian-Pacific Association for the Study of the Liver also provide clinical guidance. However, there are still some issues that need to be addressed. In the present study, the following aspects will be introduced successively: Who should be treated in the general population according to the guidelines Treatment of specific populations infected with HBV Controversial issues in clinical practice Perspective.
Unlikely Sources Of Infection
Trace levels of HBV can also be found in saliva, tears, urine, and feces but in amounts that are highly unlikely to cause infection.
While vaccination remains the cornerstone of HBV prevention, there are ways to further reduce the risk of transmission, especially if you or someone in your household has hepatitis B:
- Wash your hands with soap and water if exposed to blood.
- Avoid sharing razors or toothbrushes.
- Use condoms during sex.
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How Is Hepatitis B Diagnosed
There are three main ways to diagnose HBV infection. They include:
- Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
- Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
- Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.
The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.
The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.
Patients With A Normal Level Of Alanine Aminotransferase
Hepatitis B virus infection is a dynamic process characterized by fluctuations in alanine ALT, which might hint toward immune-mediated virus clearance . Since the ALT level is not always indicative of inflammation in the liver, patients with normal ALT levels can present inflammation and fibrosis on liver biopsy. Thus, ALT is used as a substitute for liver inflammation when liver histology is a failure . But the challenge in defining the ULN of ALT is the difficulty of including totally healthy subjects without liver diseases, especially MAFLD , the leading cause of liver disease worldwide . An Italy study reveals that Male sex, body mass index, glucose, lipids, ferritin, hypertension, and younger age are independent predictors of ALT . Many hepatologists call for the adjustment of the ULN of ALT . In 2019 China guidelines, the ULN remains constant at 50 U/L in males and 40 U/L in females however, many studies have recommended rational values as 35 U/L in males and 23 U/L in females . In 2018 AASLD guidelines, the ALT ULN is modified as 35 U/L in males and 25 U/L in females, as described previously . In 2017 EASL guidelines and 2015 APASL guidelines, the ALT ULN is 40 U/L in both males and females . Therefore, whether patients have normal ALT levels partially depends on the ULN. The ULN values mentioned in this study are consistent with those in the literature.
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Advances In New Drugs To For Curing Hepatitis B And Hepatitis D Announced At Ilc 2021
For Immediate Release
Advances in new drugs to for curing Hepatitis B and Hepatitis D announced at ILC 2021
Thursday 24 June 2021 Leading hepatology researchers announced important new developments in hepatitis research at the International Liver Congress 2021 today. This includes new data on antivirals to cure Hepatitis B and Hepatitis D and the application of infusion chemotherapy with P-1 inhibitors to treat liver cancer.
Other announcements included a review of the impact of the COVID-19 pandemic on efforts to eliminate Hepatitis C in the USA and some encouraging data from a trial of a new liver dialysis device to treat acute on chronic liver failure .
Scientists and advocates have long argued that if we are realistically going to eliminate Hepatitis B, then we will need a functional cure, said Philip Newsome, Secretary General of EASL and Professor of Experimental Hepatology and Director of the Centre for Liver Research at the University of Birmingham in the UK. The results from the trial of RNAi therapeutic drug VIR-2218 are an encouraging example that a cure is possible sooner than later with potential real-world implications for the 300 million people living with the disease.
Todays official press conference highlighted five studies covering treatment and cure research for hepatitis and acute on chronic liver failure selected from over 1500 abstracts being presented at ILC 2021.
Impact of COVID-19 on eliminating Hepatitis in the U.S.
What You Should Know About Hepatitis B:
HBV is transmitted by blood-blood contact, by sexual contacts or directly from a mother to her child around birth. The latter is the most frequent route of transmission resulting in chronic infection, of unrecognized for decades. Adolescents and adults who are not vaccinated can catch the virus during unprotected sexual contact or by contaminated blood products or instruments, e.g. by tattooing or any invasive procedure, or by drug abuse with contaminated syringes and supplies.
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The Best Way To Prevent Hepatitis B Is To Get Vaccinated Hepatitis B Vaccines Are Safe Available And Effective
Viral Hepatitis, including Hepatitis B, is a public health problem worldwide at least as dangerous as HIV, tuberculosis or malaria. Despite the significant burden it places on individuals and health systems in all regions of the world, hepatitis B has been largely ignored as a health and development priority and numbers remained constantly high over the past decades. According to WHO estimates from 2015, more than 250 million people were living with chronic hepatitis B infection leading to more than 880 000 deaths per year. Only 10.5% of all individuals estimated to be living with hepatitis B, even knew they were infected, and only 16.7% of those diagnosed were receiving treatment. Without specific action, the number of humans living with hepatitis B virus is expected to remain at the current, high levels for the next 4050 years, with a cumulative 20 million deaths occurring between 2015 and 2030. The TherVacB Project is working hard to support the United Nations Sustainable Development Goal number 3.3 calling for specific action to combat viral hepatitis by raising awareness and by developing a cure.
More than 3 % of the world population is infected with the hepatitis B virus that is more than 250 million people
Only 1 in every 10 people is aware of their hepatitis B virus infection
A vaccination can protect you from the disease
Every 30 seconds a person dies of the consequences of a hepatitis B virus infection
Update On Prevention Diagnosis And Treatment Of Chronic Hepatitis B: Aasld 2018 Hepatitis B Guidance
This AASLD 2018 Hepatitis B Guidance is intended to complement the AASLD 2016 Practice Guidelines for Treatment of Chronic Hepatitis B1 and update the previous hepatitis B virus guidelines from 2009. The 2018 updated guidance on chronic hepatitis B includes updates on treatment since the 2016 HBV guidelines and guidance on screening, counseling, and prevention specialized virological and serological tests monitoring of untreated patients and treatment of hepatitis B in special populations, including persons with viral coinfections, acute hepatitis B, recipients of immunosuppressive therapy, and transplant recipients.
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Transmission Symptoms And Treatment
How is HBV transmitted?
HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids , including
- sex with a partner who has HBV infection
- injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- birth to a person who has HBV infection
- contact with blood from or open sores on a person who has HBV infection
- exposures to needle sticks or sharp instruments and
- sharing certain items with a person who has HBV infection that can break the skin or mucous membranes , potentially resulting in exposure to blood.
How long does HBV survive outside the body?
HBV can survive outside the body and remains infectious for at least 7 days .
What should be used to clean environmental surfaces potentially contaminated with HBV?
Any blood spills should be disinfected using a 1:10 dilution of one part household bleach to 9 parts water. Gloves should be worn when cleaning up any blood spills.
Who is at risk for HBV infection?
The following populations are at increased risk for becoming infected with HBV:
- Infants born to people with HBV infection
- Sex partners of people with HBV infection
- Men who have sex with men
- People who inject drugs
- Household contacts or sexual partners of known people with chronic HBV infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Patients on hemodialysis
Who should be screened for HBV?
Clearing Acute Hepatitis B
Some studies suggest that up to 95% of adults with acute HBV infection will spontaneously clear the virus, usually within six months, with no lasting repercussions.
Chronic hepatitis B occurs when the immune system does not clear the virus. Around one of every 20 people acutely infected with HBV will progress to this persistent stage of infection.
Chronic hepatitis B is a slowly progressive disease in which ongoing inflammation causes the gradual scarring of the liver. This can lead to cirrhosis and hepatocellular carcinoma .
However, the course of chronic HBV infection is not set. Some people may progress faster than others, while others may never develop overt symptoms.
- The risk of cirrhosis in people with chronic hepatitis B is approximately 10% to 20% over 20 years, increasing to 40% after 30 years.
- The risk of hepatocellular carcinoma increases by 2% and 3% per year in people with HBV and cirrhosis. People without cirrhosis can also get it, but the annual risk drops to around 0.02%.
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How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
B Aware Get Tested And Get Vaccinated
Ask your doctor to test you for hepatitis B virus infection, and
IF YOU ARE NOT INFECTED:
about getting the hepatitis B vaccine
IF YOU ARE INFECTED:
discuss with your doctor how to managehepatitis B. Frequently visit your liverspecialist or physician to check up on thevirus & prevent liver damage
For more detailed information about hepatitis B disease, prevention, diagnosis and a list of currently available treatments and those under development we kindly refer to our partner, the Hepatitis B Foundation.
Hep B community
Join the HepBcommunity.org, a new global online forum dedicated to supporting those living with and affected by hepatitis B.
If you are not sure whether you have been vaccinated and dont know your personal status there are opportunities for the public to get tested for potential HBV infection.
European test finder
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