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Published on: June 6, 2025
Can donors with prior hepatitis be safely used for heart transplantation?
Steven D Mawhorter1, Robin K Avery
1Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. mawhors@ccf.org
Insights
Using donor hearts with prior hepatitis B or C infection is increasingly viable. New treatments and testing, like nucleic acid testing, improve safety for heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Infectious Diseases
Background:
- Heart transplantation is a critical intervention for end-stage heart failure.
- Immunosuppression is vital post-transplant to prevent rejection.
- Viral infections in donors pose a transmission risk to recipients.
Purpose of the Study:
- To evaluate the rationale for using donor organs from individuals with prior hepatitis B or C infection.
- To assess risks and benefits associated with hepatitis B/C positive donor hearts in transplantation.
Main Methods:
- Systematic literature search of Medline and PaperChase databases.
- Review of references in relevant articles on hepatitis B, hepatitis C, and heart transplantation.
Main Results:
- Donor and recipient screening for hepatitis B and C is crucial for risk stratification.
- Nucleic acid testing (NAT) for hepatitis B DNA and hepatitis C RNA offers advanced diagnostic information.
- Serologic testing remains important for initial assessment.
Conclusions:
- Hepatitis B vaccination can mitigate recipient risk prior to heart transplantation.
- Effective treatments for hepatitis B and C support the consideration of utilizing infected donor organs.
- The absence of a hepatitis C vaccine necessitates careful risk-benefit analysis.
Background:
Heart transplantation represents a significant life-saving and increased quality-of-life intervention for patients with refractory cardiac failure. Successful transplantation requires continuous immunosuppression to avoid immune rejection. Unfortunately, persistent viral infections in donors may be transmitted to recipients in the process of heart transplantation. With the severe shortage of available organs and significant waiting list mortality there is a rationale for considering use of organs from donors with evidence of prior hepatitis B and/or hepatitis C infection.
Methods:
Published literature articles were searched using Medline, PaperChase and further review of references in relevant articles on issues related to hepatitis B and hepatitis C and heart transplantation.
Results:
Donor and recipient testing for hepatitis B and hepatitis C is important for relative risk assessment. Nucleic acid testing for hepatitis B DNA and hepatitis C RNA represent emerging technologies, which may add valuable information to traditional serologic testing.
Conclusions:
Heart transplant recipient risk may be modified by vaccination against hepatitis B before transplantation. There is currently no available vaccine for hepatitis C. Recently described effective treatments for hepatitis B and hepatitis C provide further rationale for reconsideration of using hearts from donors with evidence of hepatitis B and/or hepatitis C infection.
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