American Association for the Study of Liver Diseases and Turkish Association for the Study of the Liver (AASLD/TASL): Evolving Challenges in Management of Hepatitis B/Hepatitis D Coinfection and Use of HBsAg–Positive Donor Livers in Transplantation

Chronic hepatitis B virus (HBV) infection remains a major global public health challenge, affecting an estimated 250 million individuals worldwide. Chronic hepatitis B (CHB) is a leading cause of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality. Approximately 5% to 10% of persons with CHB are coinfected with hepatitis D virus (HDV), a defective virus that depends on hepatitis B surface antigen (HBsAg) for its replication and life cycle. Chronic HDV infection is associated with accelerated progression to cirrhosis, a higher incidence of HCC, and substantially increased liver-related morbidity and mortality compared with HBV monoinfection. In parallel, the expanding use of HBsAg–positive donor livers in transplantation has emerged as an important and evolving clinical consideration, particularly in the context of HBV/HDV coinfection. Faculty for this program review the clinical course, management, and complications of chronic hepatitis B—highlighting the impact of HBV/HDV coinfection—and discuss emerging considerations in liver transplantation with HBsAg–positive donors. Topics include: current and emerging treatment options for HBV/HDV coinfection; molecular mechanisms driving HCC development in patients with CHB (with or without HDV coinfection) versus other HCC etiologies; clinical presentation, tumor characteristics, and patient outcomes in persons with CHB–related HCC compared with those with non-CHB–related HCC; and the clinical feasibility and safety protocols associated with use of HBsAg–positive cadaveric donors, including the selection of appropriate recipients and the implementation of lifelong antiviral prophylaxis.