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Hepatitis B virus (HBV) and hepatitis D virus (HDV) are hepatotropic viruses that can have a significant impact on patients undergoing solid organ and hematopoietic stem cell transplants. In the setting of transplant immunosuppression, patients with HBV or HDV coinfection can have acceleration in the natural history of their liver diseases with increased risk of developing cirrhosis, decompensation, and hepatocellular carcinoma. Immunosuppression can also reactivate HBV in patients with previous immune control. Moreover, with the national organ shortage and worsening opioid epidemic, increasing rise in donor transmission and de novo HBV can be expected. Appropriate screening, vaccination, prophylaxis, and treatment of those patients at risk for these potential complications can have a great impact on their post-transplant outcomes. Management of HBV and HDV can be complex and depends on the type of organ transplant, degree of immunosuppression, and donor/recipient HBV exposure/immune status. This process of evaluation and management starts before the transplant event with serologic screening of donors and recipients and pre-transplant vaccination of susceptible recipients, and it continues well after transplant with close monitoring and careful consideration of antiviral prophylaxis and treatment. If done successfully, outcomes of patients at risk for HBV complications can be similar to those without HBV.

DOI: 10.1007/978-3-030-01751-4_37-1