Outcomes in patients who are hepatitis B surface antigen-positive before transplantation: An analysis and study using the Joint ISHLT/UNOS Thoracic Registry

Background: Hepatitis B surface antigenemia (HBsAg) has been considered at least a relative contraindication for heart transplantation, yet patients h ave undergone liver transplantation for hepatitis B-induced chronic liver d isease, albeit with poorer results than for other liver diseases. The impac t of asymptomatic hepatitis B infection on heart transplant outcome is not known. Methods: To examine this question? we queried the Joint International Socie ty for Heart and Lung Transplantation/United Network of Organ Sharing Thora cic Registry for all patients undergoing heart transplantation who had been identified as positive for HBsAg before transplantation. We then sent a 4- question data instrument to the centers responsible for the identified pati ents. Seventy-eight patients were identified. Of the 78 data forms sent, 53 forms were returned with the requested data. Of the 53 data forms returned , the centers incorrectly identified 23 patients as positive for HBsAg, res ulting in 30 patients who were confirmed as HBsAg positive and who served a s the final cohort for this analysis. Results: The cohort included 24 males and 6 females, with a mean age of 46 +/- 16 years (range 0 to 68 years). Eleven patients had coronary artery dis ease, 14 had dilated cardiomyopathy, and 5 patients had a variety of other cardiac diseases. Of those tested at most recent follow-up, 20 of 25 patien ts continued to be positive for HBsAg, whereas 7 of 21 patients studied had converted and were hepatitis B serum antibody-positive. Approximately 37% of the patients had evidence of active hepatic inflammation or cirrhosis. W e found a statistically significant correlation between positivity for hepa titis C antibodies and clinical liver disease (p = 0.0105). No difference i n survival could be demonstrated between the study cohort and a reference h eart transplant cohort, yet 5 of the 9 deaths were considered to be related to hepatitis B. Conclusions: These data demonstrate that clinical liver disease is common p osttransplantation in HBsAg+ patients who presumably have no overt liver di sease at the time of transplantation. Despite the inability to show a survi val difference in this cohort, the fact that the majority of deaths were re lated to hepatitis B should suggest caution in accepting HBsAg+ patients fo r cardiac transplantation.