Hepatitis B virus infection in heart transplant recipients in a hepatitis B endemic area
Journal
Journal of Heart and Lung Transplantation
Journal Volume
20
Journal Issue
8
Pages
865-875
Date Issued
2001
Author(s)
Abstract
Background: Hepatitis B virus (HBV) infection is hyperendemic in Taiwan. It is almost impossible for us to reject organ donors or recipients with positive serum hepatitis B surface antigen (HBsAg). We report our experience with HBV infection in heart transplant recipients with particular attention to outcome of recipients who were HBsAg+ or who had received donor hearts from HBsAg+ donors. Methods: We performed a retrospective review of medical records. Results: In the study, we included 101 heart recipients with post-transplant survival of more than 6 months. According to pre-transplant HBV serology markers, we divided patients into 4 groups. Group 1 (n = 8) had been HBsAg+ at the time of heart transplantation. Of these, 6 patients had HBV reactivation in the post-transplant follow-up and needed lamivudine treatment. Complete response was achieved in all 6 patients; however, HBV recurrence occurred in 1 patient after 8 months of lamivudine treatment. The recurrence remained under partial control. Group 2 (n = 16) was HBV na?ve at the time of heart transplantation. Of these, 2 received HBsAg+ donor hearts under perioperative hepatitis B immunoglobulin prophylaxis. HBV infection was successfully prevented in 1 patient, but the other contracted HBV hepatitis, which was successfully treated with lamivudine. In Group 2, 10 patients received donor hearts from anti-HBs+ donors, and none contracted HBV hepatitis after transplantation. Group 3 (n = 55) had protective anti-HBs antibody at the time of heart transplantation either from previous HBV vaccination (n = 10) or from natural HGB infection (n = 45). HBsAg+ donor hearts were transplanted into 2 patients with anti-HBs from previous HBV vaccination, and into 8 patients with anti-HBs form natural HBV infection. However, none of these 10 patients who received HBsAg+ donor hearts had HBV hepatitis after transplantation. Group 4 (n = 22) was HBs-, anti-HBs-, and anti-HBc+ at the time of heart transplantation. Of these, 7 patients received HBsAg+ donor hearts. Six patients experienced no HBV hepatitis after heart transplantation, and serum HBV DNA by polymerase chain reaction (PCR) at the time of heart transplantation was negative in all 6 patients. One patient had HBV hepatitis after transplantation, and serum HBV DNA by PCR at the time of heart transplantation also was positive. Conclusion: HBV reactivation after the heart transplantation was common but usually well controlled with lamivudine treatment. Therefore, HBV carrier status should not contraindicate heart transplantation. HBsAg+ donor hearts were safely transplanted into anti-HBs+ recipients; therefore, HBsAg+ itself was not a contraindication to heart donation. Patients with HBsAg-, anti-HBs-, anti-HBc+, and negative HBV DNA in the serum by PCR could be protected from HBV infection from HBsAg+ donor hearts. However, patients with HBsAg-, anti-HBs-, anti-HBc+, and positive HBV DNA in the serum by PCR should be recognized as HBV carriers and closely followed for potential HBV flare-up after heart transplantation. Copyright ? 2001 International Society for Heart and Lung Transplantation.
SDGs
Other Subjects
hepatitis B antibody; hepatitis B surface antigen; lamivudine; virus antibody; virus DNA; adult; article; clinical article; endemic disease; heart transplantation; hepatitis B; Hepatitis B virus; human; medical record; organ donor; polymerase chain reaction; priority journal; recipient; recurrence risk; retrospective study; serology; survival time; Taiwan; treatment outcome; vaccination; virus reactivation; Adolescent; Adult; Aged; Child; Child, Preschool; Endemic Diseases; Female; Follow-Up Studies; Heart Transplantation; Hepatitis B; Hepatitis B Surface Antigens; Humans; Infant; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Taiwan; Tissue Donors
Type
journal article