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Hepatitis B in Heart Transplant Donors and Recipients: A Systematic Review and Meta-Analysis
Colin C Yost1, Diana C Jimenez1, Matthew P Weber1
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Using hepatitis B virus (HBV) positive donors for heart transplants (D+/R-) is safe and effective. This approach reduces active HBV infections and mortality compared to using HBV negative donors (D-/R+), with similar survival rates.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Immunology
Background:
- The shortage of donor organs for heart transplantation is a significant clinical challenge.
- Utilizing organs from hepatitis B virus (HBV) positive donors could expand the donor pool.
- Evaluating the safety and efficacy of HBV donor heart transplantation is crucial.
Approach:
- A systematic review and meta-analysis was conducted.
- Studies involving heart transplants with HBV positive donors and/or recipients were identified.
- Outcomes were compared between D+/R- (HBV positive donor, HBV negative recipient) and D-/R+ (HBV negative donor, HBV positive recipient) groups.
Key Points:
- 163 patients from 13 studies were analyzed.
- Active post-transplant HBV infection occurred in 11% of D+/R- recipients versus 33% of D-/R+ recipients.
- Hepatitis-related mortality was 0% in D+/R- recipients and 7% in D-/R+ recipients.
- One-year post-transplant survival was comparable (83% for D+/R- vs. 81% for D-/R+).
Conclusions:
- HBV D+/R- heart transplantation is associated with lower rates of active hepatitis B infection and reduced hepatitis-related mortality compared to D-/R+ transplantation.
- One-year survival rates are comparable between the two groups.
- Further research using HBV nucleic acid testing is needed to fully assess donor-derived infection risks.
Introduction:
Expanding the heart donor pool to include patients with hepatitis B virus (HBV) could help ameliorate the organ shortage in heart transplantation. We performed a systematic review and meta-analysis to evaluate the management and recipient outcomes of D+/R- and D-/R+ heart transplants.
Methods:
An electronic search was performed to identify all relevant studies published on heart transplants involving HBV+ donors and/or HBV+ recipients. A comparison was performed between two groups where heart transplants were performed a) D+/R- (n = 98) versus b) D-/R+ (n = 65).
Results:
Overall, 13 studies were selected, comprising 163 patients. Mean patient age was 55 y (95% CI: 39, 78) and 79% (69, 86) were male. Active post-transplant HBV infection requiring antiviral treatment occurred in 11% (1, 69) of D+/R- recipients and 33% (9, 71) of D-/R+ recipients. Post-transplant antiviral therapy was given to 80% (6, 100) of D+/R- recipients compared to 72% (42, 90) of D-/R+ recipients (P = 0.84). Hepatitis-related mortality was observed in no D+/R- recipients and 7% (2, 27) of D-/R+ recipients. Survival 1-y post-transplant was comparable between both groups at 83% (83, 92) and 81% (61, 92) for D+/R- and D-/R+ transplants, respectively.
Conclusions:
Our review found that HBV D+/R- heart transplantation was associated with fewer active hepatitis infections and lower hepatitis-related mortality than D-/R+ transplantation, with comparable survival at 1 y. Additional studies utilizing HBV nucleic acid testing (NAT) to compare outcomes with HBsAg+ and anti-HBc+ donors are crucial to reach more definitive conclusions about the risk of donor-derived infections in this context.
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