Heart transplantation using donors positive for hepatitis.
From May 1994 to September 2003, 177 hearts were procured for heart transplantation (HTx) from donors ranging in age from 1 year 2 months to 66 years 5 months (mean = 30 years). All donors and recipients received serologic tests for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs), and hepatitis C virus antibody (anti-HCV). Thirty-two donors were HBsAg-positive and another four were anti-HCV-positive. Two HBsAg-positive donors were transplanted to patients with no previous evidence of hepatitis. After HTx, one received hepatitis B immunoglobulin prophylaxis and no hepatitis was noted during a 5 years follow-up. The other seroconverted at 4 months after HTx, requiring lamivudine treatment. Another four HBsAg-positive donors were transplanted to HBsAg-positive recipients. All four recipients had hepatitis flare-ups requiring lamivudine treatment. The other 26 HBsAg-positive donors were transplanted to anti-HBs-positive recipients. None suffered from hepatitis. Among the four patients receiving anti-HCV-positive hearts, seroconversion was noted in one recipient at 26 months. This patient never had clinical hepatitis before he died of allograft rejection at 3 years after HTx. The other three recipients remain anti-HCV negative during follow-up of 80, 50, and 46 months. It was concluded the hepatitis B- or C-positive donors could be used as heart donors for status 1 patients. Donors with positive HBsAg may be transplanted to anti-HBs-positive recipients with no HBV infection.
Wang
S-S
SS
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. sswang@ha.mc.ntu.edu.tw
Chou
N-K
NK
Ko
W-J
WJ
Yu
H-Y
HY
Chen
Y-S
YS
Hsu
R-B
RB
Huang
S-C
SC
Chi
N-H
NH
Tsao
C-I
CI
Lai
M-Y
MY
Liau
C-S
CS
Lee
Y-T
YT
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001926:Brain Death; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000502:physiology* / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007223:Infant; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*
D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine