title: Long-term outcome of chronic hepatitis B in heart transplant recipients.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Medizinische Hochschule Hannover, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Wedemeyer
authors.forename: K
authors.initials: K
authors.lastname: Pethig
authors.forename: D
authors.initials: D
authors.lastname: Wagner
authors.forename: P
authors.initials: P
authors.lastname: Flemming
authors.forename: P
authors.initials: P
authors.lastname: Oppelt
authors.forename: D R
authors.initials: DR
authors.lastname: Petzold
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
authors.forename: K H
authors.initials: KH
authors.lastname: Boeker
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000097:blood*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000410:Alanine Transaminase; D001663:Bilirubin