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Heart transplantation using donors positive for hepatitis
1Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. sswang@ha.mc.ntu.edu.tw
Transplantation Proceedings
|November 25, 2004
Summary
Hepatitis B surface antigen (HBsAg)-positive and hepatitis C virus antibody (anti-HCV)-positive donors can be safely used for heart transplantation (HTx), especially for status 1 patients. Careful recipient selection, like matching HBsAg-positive donors with anti-HBs-positive recipients, minimizes hepatitis risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Heart transplantation (HTx) is a life-saving procedure for end-stage heart failure.
- Donor organ scarcity necessitates exploring utilization of organs from donors with infectious markers.
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant global health concerns.
Purpose of the Study:
- To evaluate the safety and outcomes of using hepatitis B surface antigen (HBsAg)-positive and hepatitis C virus antibody (anti-HCV)-positive donors for heart transplantation.
- To determine the risk of HBV and HCV transmission to recipients from seropositive donors.
- To assess the impact of donor-recipient hepatitis serologic matching on post-transplant outcomes.
Main Methods:
- Retrospective analysis of 177 heart procurements for HTx between May 1994 and September 2003.
- Serologic testing for HBsAg, anti-HBs, and anti-HCV in all donors and recipients.
- Categorization of donor-recipient pairs based on hepatitis serologic status.
- Clinical and laboratory follow-up for post-transplant hepatitis and other complications.
Main Results:
- Thirty-two donors were HBsAg-positive; four were anti-HCV-positive.
- HBsAg-positive donors transplanted to anti-HBs-positive recipients showed no hepatitis.
- One of four recipients of anti-HCV-positive hearts seroconverted 26 months post-HTx.
- HBsAg-positive donors transplanted to hepatitis-negative recipients resulted in one case of hepatitis B requiring treatment.
- HBsAg-positive donors transplanted to HBsAg-positive recipients led to hepatitis flare-ups requiring treatment.
Conclusions:
- Hepatitis B and C-positive donors can be utilized for heart transplantation, particularly for status 1 patients.
- Transplanting HBsAg-positive donors to anti-HBs-positive recipients is a safe strategy to prevent HBV infection.
- Careful donor-recipient matching and prophylaxis can mitigate risks associated with using seropositive donors.