Hepatitis virus infections in heart transplant recipients: Epidemiology, natural history, characteristics, and impact on survival

Background & Aims: We have observed a high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in heart transplant recipients (HTRs). The aim of this study was to assess the epidemiology, natural histo ry, and clinical and biological characteristics of viral hepatitis in HTRs. Methods: From 1983 to 1992, 874 patients underwent heart transplantation a t the Pitie-Salpetriere Hospital, Paris, France, 459 of whom qualified for analysis. A total of 140 patients had posttransplantation hepatitis B, C, o r non-A-E. Sixty-nine patients developed HBV infection, 49 HCV infection, 1 1 HBV-HCV coinfection, and 11 non-A-E hepatitis, Results: HBV was transmitt ed nosocomially from patient to patient, most likely during endomyocardial biopsies. HCV was mainly transmitted through blood transfusions or the tran splanted organ. Clinical and biological findings after 2 years of follow-up showed that 3 patients with an HBV genotype A precore mutant had severe or subfulminant hepatitis and that patients with HBV and HCV infection always progressed to chronicity. In general, patients had mild alanine aminotrans ferase level increases, a high level of viral replication, and few severe h istologic Lesions, except for patients infected by precore HBV mutants. Pat ients coinfected by HBV and HCV tended to have more severe liver lesions. T he survival rate 5 years after transplantation in patients with viral hepat itis (HBV, 81%; HCV, 89%; HBV and HCV coinfection, 100%; non-A-E hepatitis, 73%) was similar to that in patients without liver test abnormalities (76% ). The actuarial survival curve was also similar in patients with or withou t liver test abnormalities. Conclusions: In our experience, histologic live r lesions do not progress rapidly in patients with post-heart transplant in fection caused by HBV or HCV. HBV or HCV infection seems to have little imp act on the 5-year survival rate of HTRs.