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HBV and HCV infections in heart transplant recipients
S Fagiuoli1, F Minniti, S Pevere
1Department of Surgical and Gastroenterological Sciences,University of Padova, Padova, Italy. fagiuoli@ux1.unipd.it
Insights
Hepatotropic viral infections like hepatitis B virus (HBV) and hepatitis C virus (HCV) pose risks to heart transplant (HTx) recipients. While prevalence is similar to the general population, these infections can lead to chronic liver disease and cirrhosis in HTx patients.
Area of Science:
- Hepatology
- Transplant Medicine
- Infectious Diseases
Background:
- Heart transplant (HTx) recipients are susceptible to hepatotropic viral infections, including hepatitis B virus (HBV) and hepatitis C virus (HCV).
- The impact of these viral infections on long-term survival after HTx is not well understood.
- This study aimed to investigate the prevalence, clinical characteristics, and natural history of HBV and HCV in HTx recipients.
Purpose of the Study:
- To determine the prevalence of HBV and HCV infections in a cohort of heart transplant recipients.
- To describe the clinical features and outcomes of these viral infections post-transplant.
- To assess the natural history and impact of HBV and HCV on HTx patient survival.
Main Methods:
- Retrospective analysis of 360 consecutive heart transplant recipients.
- Monitoring of clinical status, liver injury markers, and viral serology (HBV and HCV) post-transplantation.
- Follow-up duration averaged 8 years.
Main Results:
- 16.5% of HTx recipients tested positive for HBV or HCV (3.1% HBV, 12% HCV, 0.5% co-infection).
- HCV prevalence was significantly lower in recipients transplanted after 1990 (4.2%) compared to before (28%).
- All HBV-positive and 58% of HCV-positive recipients developed chronic liver disease; 16% developed cirrhosis, and 8% died from end-stage liver disease.
Conclusions:
- The prevalence of HBV and HCV in HTx recipients is comparable to the general population.
- HBV and HCV infections exhibit active viral replication and aggressive natural history in HTx recipients.
- Improved screening and vaccination policies likely contribute to the lower prevalence of HBV and HCV in recent HTx cohorts.
Background:
Heart transplant (HTx) recipients risk acquiring hepatotropic viral 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 features, and natural history of HBV and HCV infections in a cohort of HTx recipients.
Methods:
We retrospectively studied 360 consecutive patients who had undergone HTx. Clinical picture, hepatic injury indexes, and HBV/HCV viral serology 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 series of HTx recipients and much lower than expected in the age- and sex-matched general population. All HBV-positive and 58% of HCV-positive recipients developed chronic liver disease. Sixteen percent of patients developed cirrhosis during follow-up, and 8% died of end-stage liver disease.
Conclusions:
The prevalence of HBV and HCV in a large population of HTx recipients 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.