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Long-term outcome of chronic hepatitis B in heart transplant recipients
H Wedemeyer1, K Pethig, D Wagner
1Department of Gastroenterology, Medizinische Hochschule Hannover, Germany.
Insights
Hepatitis B infection in heart transplant recipients frequently leads to chronic liver disease and cirrhosis within ten years. Liver failure is a significant cause of death, underscoring the need for HBV vaccination before transplantation.
Area of Science:
- Hepatology
- Transplant Medicine
- Infectious Diseases
Background:
- Hepatitis B is prevalent in organ transplant recipients, impacting outcomes.
- Previous studies focused on liver and kidney transplants; long-term outcomes in heart transplant recipients were unknown.
Purpose of the Study:
- To investigate the long-term outcomes of hepatitis B virus (HBV) infection in heart transplant recipients.
Main Methods:
- A cohort of 345 heart transplant survivors (1+ year post-transplant) was studied.
- 74 patients were hepatitis B surface antigen (HBsAg)-positive; 69 acquired HBV post-transplant.
- Follow-up averaged 105 months.
Main Results:
- HBsAg-positive patients experienced significant alanine aminotransferase (ALT) elevations post-infection.
- Over 55% developed severe fibrosis or cirrhosis within a decade.
- Mortality was higher in the HBV-infected group (45.9% vs. 28.8%), with liver failure being a key cause of death.
Conclusions:
- Hepatitis B infection post-heart transplant commonly results in chronic liver disease and cirrhosis.
- Liver failure is a frequent cause of mortality in these patients.
- Mandatory hepatitis B virus (HBV) vaccination for all organ transplant candidates, especially before heart transplantation, is crucial.
Background:
Hepatitis B is common in organ transplant recipients. It adversely affects the prognosis after liver and kidney transplantation. The long-term outcome of hepatitis B virus (HBV) infection in heart transplant recipients has not been studied before.
Methods:
Between July 1984 and June 1993, 436 patients underwent heart transplantation at the Hannover Medical School. A total of 345 patients survived for more than 1 year and were included in this study. Of these, 74 were found to be hepatitis B surface antigen (HBsAg)-positive during follow-up; 69 acquired HBV infection at known time points 25+/-17 months after transplantation, and 5 had already been infected before heart transplantation. Mean follow-up was 105 (range, 25-157) months.
Results:
Patients developed significant alanine aminotransferase (ALT) elevations after HBV infection, which peaked and then remained above normal. Preinfection levels of ALT were 15.4+/-6.4 U/L, peak values were 71.2+/-47.2 U/L, and mean values after HBV infection were 28.9+/-14.6 U/L. All patients remained HBsAg-positive. Thirteen patients (18%) became HBeAg-negative during follow-up, 10 with negative quantitative HBV-DNA assays. Mean HBV-DNA levels in the remaining patients were 292+/-267 (range, 0-978) pg/ml. Thirty-four patients died during follow-up (45.9%) compared to 78/271 (28.8%) in the control group (P=0.008). Six of the HBsAg-positive patients (17.1%) died of liver failure 6.2-10.6 years (mean, 8.6) after transplantation. Histology of 25 HBsAg-positive patients more than 5 years after infection revealed severe fibrosis or cirrhosis in 14 (56%), mild fibrosis in 9 (36%), and chronic hepatitis without fibroproliferation in 2 (8%).
Conclusions:
Hepatitis B infection after heart transplantation leads to chronic liver disease in the majority of the affected patients, causing cirrhosis in more than 55% within the first decade after transplantation. Liver failure is a common cause of death in the infected group of patients. Active HBV vaccination is mandatory for all organ transplant candidates, in particular before heart transplantation.