Introduction

Vertical transmission of hepatitis B virus (HBV) remains challenging despite advances in vaccination and hepatitis B immunoglobulin (HBIG). Chronic HBV infections can lead to complications such as fulminant hepatic failure or hepatocellular carcinoma (HCC), often necessitating liver transplantation. This case series highlights perioperative management and outcomes in three pediatric patients undergoing liver transplantation for HBV-related complications, as there are no current guidelines in pediatrics.

Methods
We retrospectively reviewed three pediatric liver transplant recipients at our center between 2010 and 2024. Data were collected on patient demographics, HBV status, perioperative HBIG and antiviral regimens, and post-transplant monitoring protocols. Outcome measures included HBsAb titers, graft function, HBV DNA levels, and recurrence of HBV or malignancy.

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Results

The indications for liver transplantation were fulminant hepatic failure in a 6-month-old and HCC in two patients aged 12 and 14 years. All patients received HBIG to maintain HBsAb levels >500 IU/L during the first-month post-transplant, then the level was reduced to >100 IU/L. On average, they received HBIG 6 times (Range: 5 to 7). Pre-transplant antiviral therapy was utilized in two patients, and all of them were maintained on tenofovir post-transplant. Post-transplant, all patients demonstrated stable graft function, undetectable HBV DNA, and no recurrence of HBV. Both patients with HCC remain in remission post-transplant.

Discussion

This case series highlights the importance of perioperative management in pediatric liver transplantation for HBV-related complications. HBIG and antiviral therapy effectively prevent HBV recurrence and ensure graft stability, with targeted HBsAb levels and individualized dosing playing key roles.