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Published on: February 19, 2019
Heart transplantation in patients with chronic hepatitis B: clinical evolution, molecular analysis, and effect of
Rosa Zampino1, Aldo Marrone, Enrico Ragone
1Internal Medicine and Hepatology, Second University of Naples, and Unit of Infectious and Transplant Medicine Monaldi Hospital, Italy. rosa.zampino@unina2.it
Insights
Heart transplant recipients with chronic hepatitis B virus (HBV) infection are at risk for reactivation. Lamivudine treatment can be effective, but resistance may develop, necessitating alternative therapies like adefovir.
Area of Science:
- Hepatology
- Virology
- Transplant Medicine
Background:
- Chronic hepatitis B virus (HBV) infection poses risks for heart transplant recipients.
- Immunosuppression post-transplantation can trigger HBV reactivation.
Purpose of the Study:
- To assess clinical outcomes and molecular changes in heart transplant recipients with chronic HBV.
- To evaluate the efficacy of lamivudine in managing HBV reactivation and resistance.
Main Methods:
- Sequencing of HBV surface/core-promoter/precore/core regions in nine heart transplant recipients.
- Monitoring of clinical parameters (ALT, HBV-DNA) and treatment responses.
Main Results:
- Seven out of nine patients experienced HBV reactivation post-transplantation.
- Lamivudine was initially effective, but three patients developed resistance mutations (rt-L180M, rt-M204V).
- Adefovir treatment successfully managed severe reactivation in patients with lamivudine resistance.
Conclusions:
- Immunosuppression is a key factor in HBV reactivation and disease progression in heart transplant recipients.
- Preemptive lamivudine treatment may aid early management, but monitoring for resistance is crucial.
Abstract:
We evaluated clinical evolution and hepatitis B virus (HBV) molecular changes in heart recipients with chronic HBV infection before transplantation, and studied the effects of lamivudine treatment in patients who experienced HBV reactivation. Nine patients with chronic HBV infection who underwent heart transplantation were investigated. HBV surface/core-promoter/precore/core regions were sequenced. Prior to transplantation, all nine patients had consistently normal ALT and low HBV-DNA levels. Seven experienced HBV reactivation after transplantation (ALT elevated, HBV-DNA>200.000 cps/ml). Lamivudine treatment was initially effective in all patients; three patients during the second year of treatment developed lamivudine resistance-associated mutations (rt-L180M, rt-M204V) with severe disease reactivation, remitted after switch to adefovir treatment. No other significant HBV mutations were identified in the genomic regions studied. Immune suppression is crucial in the reactivation of previous inactive HBV infection and in the liver disease progression in heart recipients. Preemptive lamivudine treatment could be useful in the early management of these patients.
