Hepatitis D virus (HDV) infection remains a major cause of severe liver disease among hepatitis B virus (HBV)-infected patients, contributing to accelerated progression to cirrhosis and hepatocellular carcinoma. Pegylated interferon-α remains the first-line therapy for chronic HDV infection in most cases. However, despite its approval for HBV and hepatitis C virus (HCV) infections, its use in HDV is largely driven by a lack of other options and is constrained by its limited efficacy, suboptimal durability of response, and a substantial side effect profile. Meanwhile, bulevirtide, an entry inhibitor, became the first agent to be approved for use in chronic HDV infections by the European Medicines Agency (EMA), and several other therapies are currently being investigated as well. In this review, we provide updates on recent advancements in HDV treatment and novel therapies.

Alcoholic liver disease(ALD) is considered as a growing public health issue with universally increasing disease burden. Various genetic and environmental factors play role in its etiology. ALD recently has become the major indication for Liver Transplantation (LT). Most LT programs select their candidates by adhering to six months of alcohol abstinence policy. Nevertheless, early liver transplantation (ELT) has become a subject of research, both in Europe and the United States, as an effective and lifesaving option among highly selected severe alcohol-associated hepatitis (SAH) patients. ELT is a promising way in the management of ALD, perhaps changing clinical practice for carefully selected patient groups.

Liver transplantation (LT) remains the only definitive treatment for end-stage liver disease and selected hepatic malignancies. However, persistent organ shortages continue to drive high waitlist mortality worldwide. Hepatitis B virus (HBV)-positive donors, including hepatitis B surface antigen (HBsAg)-positive and anti-hepatitis B core antibody–positive (HBsAg negative) donors, represent an increasingly important but historically underused resource. The introduction of high-barrier nucleos(t)ide analogs, the selective use of hepatitis B immunoglobulin, and pre- and posttransplant vaccination have markedly reduced viral transmission, enabling safe transplantation in both HBV-immune and selected HBV-naive recipients. Regional guidelines and consensus statements, including those from the American Society of Transplantation, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, and Asian Pacific Association for the Study of the Liver, support individualized, risk-directed prophylaxis and posttransplant surveillance. Ethical considerations, particularly informed consent and risk–benefit discussions in the setting of organ scarcity, remain central to clinical decision-making. Large cohort studies demonstrate comparable graft and patient survival with HBV-negative grafts, along with economic advantages and expansion of the donor pool. However, evidence in HBV-naive recipients remains limited, with most data derived from immune or previously infected recipients, highlighting the need for careful patient selection and robust prophylaxis. Available evidence on the use of HBsAg-positive donors in HBV-naive recipients is obtained predominantly from cadaveric donor transplantation, as experience with HBsAg-positive living donors remains limited. This narrative review summarizes current evidence on the use of HBsAg-positive grafts in LT, with a focus on HBV-naive recipients, based predominantly on cadaveric donor experience. Cite this article as: Bardak AE, Mujeeb A, Donmez AE, et al. Using hepatitis B surface antigen–positive donors in liver transplantation: Outcomes, prophylaxis, and monitoring with a focus on hepatitis B virus–naive recipients. Turk J Gastroenterol. Published online May 13, 2026. doi: 10.5152/tjg.2026.26018.

Alcohol-associated liver disease has become the most common reason for liver transplantation (LT) in many regions, including the US. This shift reflects the declining hepatitis C-related LTs and rising prevalence of harmful alcohol use, which increased substantially, especially during COVID-19 pandemic. Post-LT alcohol relapse leads to poor clinical outcomes, including medication non-adherence, graft dysfunction (steatosis and alcohol-related hepatitis), recurrent cirrhosis, and decreased overall survival. For patients with severe alcohol-associated hepatitis, early or expedited LT can offer a survival advantage in carefully selected candidates compared with traditional approaches requiring six months of pre-LT abstinence, without a substantial increase in hazardous relapse. Pre-LT risk assessment is essential for the candidate selection and combines psychosocial factors with validated tools such as Stanford Integrated Psychosocial Assessment for Transplantation, Hopkins psychosocial scale, sustained alcohol use post-LT, harmful alcohol use post-LT, and high-risk alcoholism relapse. Post-LT monitoring utilizing direct biomarkers (e.g., phosphatidylethanol, ethyl glucuronide) with indirect markers of alcohol-use to widen the detection window and capture both low-level and heavy use should be considered. Optimal management of alcohol-use disorder (AUD) relies on combining pharmacologic and psychosocial interventions. Among pharmacologic options, naltrexone and acamprosate are considered first-line options, whereas disulfiram is less commonly used after LT given concerns about its drug interactions. Psychosocial aspects of the management are as important as the pharmacologic aspects to maintain abstinence and reduce relapse risk. Potential barriers to participation, such as hepatic decompensation, hepatic encephalopathy, or logistical challenges, should also be recognized and addressed. This narrative review summarizes current management strategies for AUD with emphasis on the post-LT setting.

Endoscopic ultrasound (EUS) is being increasingly used for both diagnostic and therapeutic purposes in various settings in gastroenterology and hepatology. Similarly, it has also been adopted in liver transplantation (LT), and its utilization is steadily increasing. EUS strengthens LT care in both the pre-transplant and post-transplant periods. Specifically, EUS is valuable in the evaluation of liver parenchyma, portal hypertension assessment and variceal management, tissue sampling when percutaneous or transjugular approaches are contraindicated or impractical, detection and characterization of hepatic and nodal metastases—thereby refining staging and sometimes even eligibility for LT—management of postoperative collections, and enabling biliary and pancreatic interventions in altered anatomy by creating access routes. In this review, we discuss these applications of EUS, along with its current limitations and its evolving role in the setting of LT.