Current status of liver transplantation

End-stage liver disease due to viral hepatitis is a frequent indication for liver transplantation as the ultimate treatment option in Germany and worldwide. Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) lead to liver cirrhosis and progressive organ failure requiring patients to be short-listed for liver transplantation. Treatment options for viral hepatitis before and after liver transplantation have improved considerably in recent years. The effective antiviral treatment of chronic HBV infections with up to date nucleos(t)ide analogues featuring high antiviral potency and low rates of resistance has been followed by a considerable decrease in hepatitis B associated liver transplantations. The effective but expensive combination prophylaxis of human hepatitis B immunoglobulin (HBIG) and nucleos(t) ide analogues after transplantation has reduced the number of HBV reinfections to almost negligible numbers. Hepatitis C virus reinfection occurs regularly after liver transplantation. Factors such as donor age and excessive immunosuppression negatively influence the course of HCV reinfection. The practicability and value of modern triple therapy regimens including interferon, ribavirin and protease inhibitors as well as substances still in clinical development before and after liver transplantation still need to be evaluated.