1 log copies/mL on pretreatment screening tests, NA therapy should be commenced without delay. Patients with

resolved HBV infection and HBV DNA levels <2.1 log copies/mL on pretreatment screening tests should undergo regular monitoring of HBV DNA levels during and after their immunosuppressive therapy or chemotherapy. If HBV DNA levels exceed 2.1 log copies/mL during monitoring, preemptive NA therapy should be commenced. Entecavir is the recommended Rapamycin order NA. The criteria for cessation of NA therapy are the same as for cessation of NA therapy in HBsAg positive patients. For patients with resolved HBV infection, NA therapy should be continued for at least 12 months after completion of immunosuppressive therapy or chemotherapy, although cessation of NAs may be considered during this period if continued ALT normalization and HBV DNA negative conversion are seen. Close follow-up including HBV DNA monitoring is necessary for at least 12 months after cessation of NA therapy. If HBV

DNA levels exceed 2.1 log copies/mL during the follow-up period, NA therapy should be recommenced immediately. HBV reactivation is a potential problem in recipients of a liver transplant from an HBsAg negative and anti-HBc antibody positive donor. In a report from a time before prophylactic click here HBIG administration became standard, HBV reactivation occurred in 15 out of 16 recipients of liver transplants from anti-HBc antibody positive donors, one of whom died from FCH.[332] It is preferable to exclude anti-HBc antibody positive donors, but a strategy is needed selleck chemicals llc when transplantation of a liver from such a donor cannot be avoided. One such strategy is to administer HBIG during the transplantation procedure, and maintain anti-HBs antibody

levels postoperatively. Postoperative administration of NA therapy, or NA+HBIG combination therapy, is also considered useful.[333, 334] Early commencement of NA therapy following HBV reactivation has also been reported to be effective.[335] HBV reactivation is seen in a high proportion (50–94%) of HBsAg positive patients undergoing transplantation of kidneys and other organs.[336-339] Following HBV reactivation, rapid progression is seen from chronic hepatitis B to liver cirrhosis, which becomes the cause of death. Prophylactic NA therapy is recommended for HBsAg positive and/or anti-HBc antibody positive patients, commencing prior to the transplantation procedure. HBV reactivation is seen in a high proportion (≥50%) of HBsAg positive patients undergoing of hematopoietic stem cell transplantation.[340] The rate of HBV reactivation is 14–20% in patients with resolved HBV infection.[341, 342] The risk of HBV reactivation is higher with allogeneic bone marrow transplantation than with autologous bone marrow transplantation.