Long-term outcome of chronic hepatitis B in heart transplant recipients

Background. Hepatitis B is common in organ transplant recipients. It advers ely affects the prognosis after liver and kidney transplantation. The long- term outcome of hepatitis B virus (HBV) infection in heart transplant recip ients has not been studied before. Methods. Between July 1984 and June 1993, 436 patients underwent heart tran splantation at the Hannover Medical School. A total of 345 patients survive d for more than 1 year and were included in this study. Of these, 74 were f ound to be hepatitis B surface antigen (HBsAg)-positive during follow-up; 6 9 acquired HBV infection at known time points 25+/-17 months after transpla ntation, and 5 had already been infected before heart transplantation. Mean follow-up was 105 (range, 25-157) months. Results. Patients developed significant alanine aminotransferase (ALT) elev ations after HBV infection, which peaked and then remained above normal. Pr einfection levels of ALT were 15.4+/-6.4 U/L, peak values were 71.2+/-47.2 Un, and mean values after HBV infection were 28.9+/-14.6 Un. All patients r emained HBsAg-positive. Thirteen patients (18%) became HBeAg-negative durin g follow-up, 10 with negative quantitative HBV-DNA assays. Mean HBV-DNA lev els in the remaining patients were 292+/-267 (range, 0-978) pg/ml. Thirty-f our patients died during follow-up (45.9%) compared to 78/271 (28.8%) in th e control group (P=0.008). Six of the HBsAg-positive patients (17.1%) died of liver failure 6.2-10.6 years (mean, 8.6) after transplantation. Histolog y of 25 HBsAg-positive patients more than 5 years after infection revealed severe fibrosis or cirrhosis in 14 (56%), mild fibrosis in 9 (36%), and chr onic hepatitis without; fibroproliferation in 2 (8%). Conclusions. Hepatitis B infection after heart transplantation leads to chr onic liver disease in the majority of the affected patients, causing cirrho sis in more than 55% within the first decade after transplantation. Liver f ailure is a common cause of death in the infected group of patients. Active HBV vaccination is mandatory for all organ transplant candidates, ill part icular before heart transplantation.