One of the biggest problems after liver transplantation in patients with hepatitis B-related liver disease is the recurrence of hepatitis B. If no preventive measures are taken, the recurrence rate of hepatitis B in the transplanted liver after liver transplantation is as high as 80%-100%, and most of them develop into cirrhosis and hepatic failure after acute chronic hepatitis, leading to the loss of transplanted liver, and some of the patients may suffer from fulminant hepatic failure or even death. Therefore, after liver transplantation must continue to take anti-hepatitis B virus drugs to be safe. As many patients know, hepatitis B virus (HBV) is a kind of hepatophilic virus, which exclusively parasitizes in human liver cells and utilizes the liver cells for replication. It is thought that after liver transplantation, the patient’s own liver containing a large amount of HBV is replaced by a new, normal, uninfected liver, and the amount of HBV is greatly reduced, so why is it still possible for the disease to recur? The answer is: 1. because of some reasons, the virus is not treated with anti-HBV drugs before surgery or is not completely eliminated in the body due to emergency surgery, so there are residual HBV virus particles in the blood circulation after surgery; 2. after liver transplantation, there will still be residual HBV in the patient’s body, and it has been proved that HBV exists in extra-hepatic tissues such as the peripheral blood mononuclear cells, the pancreas, the spleen, the adrenal glands, the bone marrow, the lymph nodes, the heart, the small intestine, and other extra-hepatic tissues. And the replication of HBV in peripheral blood mononuclear cells plays an important role in the recurrence of hepatitis B in transplanted liver.3. Intravenous transfusion of blood products;4. Replication of HBV before transplantation, such as blood HBV has not been completely eliminated, and there is a high probability of recurrence of hepatitis B after the operation;5. Differences in the genotypes of HBV and so on. Many patients and friends may ask, I started to take lamivudine after or even before the operation, and I also regularly inject human hepatitis B immunoglobulin after the operation, can I avoid recurrence? The answer is yes. However, there are still some patients who have started to take nucleoside analogues like lamivudine and other drugs to inhibit HBV before surgery, and insist on using antibodies to neutralize the surface antigen of hepatitis B after surgery, but some patients still have recurrence of hepatitis B. Therefore, it is very important to adopt correct prevention and treatment methods, especially individualized treatment. At present, the better measures to prevent the recurrence of hepatitis B are: 1. the dose of immunosuppressant should be minimized under the premise of ensuring no rejection of the transplanted liver, especially for patients with active replication of hepatitis B virus before the operation; 2. the use of a combination of drug regimens: nucleoside analogues (such as lamivudine, etc.) + human hepatitis B immune globulin, etc.; 3. the avoidance of blood transfusion as far as possible, to reduce the chances of infection with hepatitis B; 4. dynamic Monitor HBV replication: check HBV-DNA regularly to know whether the virus is replicating or not; 5. check HBV mutation regularly: although lamivudine has achieved definite efficacy in preventing and treating recurrence of hepatitis B after liver transplantation, but long-term use of lamivudine and other drugs to inhibit HBV replication, HBV will produce mutant strains (YMDD), and at the same time, the drug can not eliminate the viral super-helical cccDNA in the nucleus of liver cells, so it may recur after stopping the drug. Therefore, relapse may occur after stopping the drug. Therefore, long-term treatment with nucleoside analogs is required. Clinical studies have found that even if antiviral drugs are applied for a long time after surgery to prevent the recurrence of hepatitis B, there will still be viral residues in the patient’s body several years later. Therefore, it is recommended that after liver transplantation for hepatitis B-related end-stage liver disease, not only should anti-HBV drugs continue to be taken but also be applied for a long time so as to ensure long-term safety.