HBV and HCV infections in heart transplant recipients

Background: Heart transplant (HTx) recipients risk acquiring hepatotropic v iral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV) , and the impact of these infections on post-HTx survival remains unclear. The aim of the present study was to define the prevalence, clinical feature s, and natural history of HBV and HCV infections in a cohort of HTx recipie nts. Methods: We retrospectively studied 360 consecutive patients who had underg one HTx, Clinical picture, hepatic injury indexes, and HBV/HCV viral serolo gy were followed post-transplant. Results: During follow-up (average, 8 +/- 3.1 years), 49 (16.5%) of the HTx recipients tested positive for at least 1 of the 2 viruses (3.1% HBV, 12% HCV, 0.5% concomitant infection). The prevalence of HCV infection in heart transplant recipients transplanted before and after 1990 was 28% and 4.2%, respectively, the latter being markedly lower (p < 0.001) than in earlier s eries of HTx recipients and much lower than expected in the age- and sex-ma tched general population. All HBV-positive and 58% of HCV-positive recipien ts developed chronic liver disease. Sixteen percent of patients developed c irrhosis during follow-up, and 8% died of end-stage liver disease. Conclusions: The prevalence of HBV and HCV in a large population of HTx rec ipients is not very different from that reported in the general population. Active viral replication of HBV and an aggressive natural history of both infections are seen in HTx recipients, however. The low prevalence of HBV- and HCV-related infection in recent series probably reflects current viral screening and vaccination policies.