If the best-matched donor has chronic hepatitis B or C, preventin

If the best-matched donor has chronic hepatitis B or C, preventing passage of virus and mitigating the effects of infection in the recipient become priorities. In HBV-positive donors, antiviral drugs will reduce viral load prior to harvest of donor cells. However, HBV may persist in donor peripheral blood cells despite clearance from serum.4 If donor cells are rendered HBV DNA-negative before harvest, passage can be prevented. All recipients of cells from hepatitis B surface antigen (HBsAg)-positive donors should receive antiviral prophylaxis. HBsAg-negative, anti-hepatitis

B core (HBc)-positive donors are viremic in fewer than 5% of cases and can be used as donors if their serum and peripheral blood stem cells are HBV DNA-negative. selleck products TAM Receptor inhibitor A donor who is naturally anti-HBs-positive is the preferred donor if the recipient is HBsAg-positive or anti-HBc-positive, as adoptive transfer of immunity can effect clearance of HBV from the recipient.5 If time permits, treatment of an HCV RNA+ donor prior to harvest of donor cells may render them less likely to transmit infection.6 Small-molecule antiviral drugs in current development may offer clinical benefit in rendering donors nonviremic, at least temporarily, to allow for harvest of HCV-free donor cells. If virus is transmitted, the acute phase of HCV infection may cause elevated

liver enzymes at 2-3 months post-HCT, after recovery of T cell function.7 Severe hepatitis is rare and the outcome of HCV-infected transplant survivors over 10 years of follow-up is no different than in survivors without HCV infection.7 Patients being considered for

HCT who have chronic hepatitis hepatic fibrosis, cirrhosis, 上海皓元医药股份有限公司 or cholestasis, are at increased mortality risk.7 HCV-infected patients may also have overall poorer survival related to infection. Patients with marginally-compensated cirrhosis (Child-Pugh B or C) should not receive high-dose conditioning regimens and may not be considered suitable candidates for HCT. Patients with Child-Pugh A cirrhosis are at risk for decompensation after HCT even if given a reduced-intensity conditioning regimen.8 Patients with myelofibrosis and amyloidosis may also evince extensive sinusoidal fibrosis. Hepatitis B-infected HCT recipients are at additional risk for fulminant liver failure if not given antiviral drugs throughout the transplant process.1 In patients with isolated anti-HBc antibodies, there is a 35% risk of HBV reactivation, usually during prednisone treatment for acute GVHD.9 Severe hepatitis B reactivation has also been seen in anti-HB/anti-HB patients and in those with occult hepatitis B.10 Antiviral prophylaxis will prevent almost all cases of fulminant hepatitis B after transplant if begun before the start of conditioning therapy in patients who are viremic (HBV DNA+) or HBs+; patients with latent HBV (anti-HB/HBV DNA−) should be monitored with HBV DNA tests after HCT and treated pre-emptively if viremia is detected.

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