title: Hepatitis virus infections in heart transplant recipients: epidemiology, natural history, characteristics, and impact on survival.
abstract: OBJECTIVE
  We have observed a high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in heart transplant recipients (HTRs). The aim of this study was to assess the epidemiology, natural history, and clinical and biological characteristics of viral hepatitis in HTRs.
  
  
  METHODS
  From 1983 to 1992, 874 patients underwent heart transplantation at the Pitié-Salpêtrière Hospital, Paris, France, 459 of whom qualified for analysis. A total of 140 patients had posttransplantation hepatitis B, C, or non-A-E. Sixty-nine patients developed HBV infection, 49 HCV infection, 11 HBV-HCV coinfection, and 11 non-A-E hepatitis.
  
  
  RESULTS
  HBV was transmitted nosocomially from patient to patient, most likely during endomyocardial biopsies. HCV was mainly transmitted through blood transfusions or the transplanted organ. Clinical and biological findings after 2 years of follow-up showed that 3 patients with an HBV genotype A precore mutant had severe or subfulminant hepatitis and that patients with HBV and HCV infection always progressed to chronicity. In general, patients had mild alanine aminotransferase level increases, a high level of viral replication, and few severe histologic lesions, except for patients infected by precore HBV mutants. Patients coinfected by HBV and HCV tended to have more severe liver lesions. The survival rate 5 years after transplantation in patients with viral hepatitis (HBV, 81%; HCV, 89%; HBV and HCV coinfection, 100%; non-A-E hepatitis, 73%) was similar to that in patients without liver test abnormalities (76%). The actuarial survival curve was also similar in patients with or without liver test abnormalities.
  
  
  CONCLUSIONS
  In our experience, histologic liver lesions do not progress rapidly in patients with post-heart transplant infection caused by HBV or HCV. HBV or HCV infection seems to have little impact on the 5-year survival rate of HTRs.
authors.affiliation: Virologie, Centre Hospitals Universitaire Angers, Angers, France. fafalulu@aol.com
authors.forename: F
authors.initials: F
authors.lastname: Lunel
authors.forename: J F
authors.initials: JF
authors.lastname: Cadranel
authors.forename: M
authors.initials: M
authors.lastname: Rosenheim
authors.forename: R
authors.initials: R
authors.lastname: Dorent
authors.forename: V
authors.initials: V
authors.lastname: Di-Martino
authors.forename: C
authors.initials: C
authors.lastname: Payan
authors.forename: C
authors.initials: C
authors.lastname: Fretz
authors.forename: J J
authors.initials: JJ
authors.lastname: Ghoussoub
authors.forename: B
authors.initials: B
authors.lastname: Bernard
authors.forename: B
authors.initials: B
authors.lastname: Dumont
authors.forename: M
authors.initials: M
authors.lastname: Perrin
authors.forename: I
authors.initials: I
authors.lastname: Gandjbachkh
authors.forename: J M
authors.initials: JM
authors.lastname: Huraux
authors.forename: L
authors.initials: L
authors.lastname: Stuyver
authors.forename: P
authors.initials: P
authors.lastname: Opolon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018450:Disease Progression; D018562:Disease Transmission, Infectious; D005260:Female; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology; D006509:Hepatitis B / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000503:physiopathology; D006526:Hepatitis C / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate