Acceptable recipient outcomes with the use of hearts from donors with hepatitis-B core antibodies.
BACKGROUND
The shortage of available donors limits cardiac transplantation. Use of hearts from patients with hepatitis-B core antibodies could expand the donor pool but are usually avoided because of concern about virus transmission. We conducted a retrospective review to determine the safety of transplanting hearts from donors with hepatitis-B core antibodies.


METHODS
We reviewed donor and recipient charts for patients who underwent transplantation at our center between January 1, 1997, and December 1, 2002.


RESULTS
A total of 541 heart transplantations were performed in this time period. Thirty-three patients (aged 47.5 +/- 18.8 years) received hearts from core-antibody-positive donors (aged 37.7 +/- 10.8 years). Of these, 5 patients received prophylactic antibiotic treatment with lamivudine after transplantation. Only 1 patient (baseline surface-antigen-negative and without prophylaxis) experienced donor-transmitted hepatitis B infection 10 months after transplantation that was treated with lamivudine. Two patients (baseline surface-antibody-negative) had hepatitis B seroconversion, becoming surface-antibody positive without evidence of infection. None of the 5 patients who received prophylaxis with lamivudine had donor-transmitted hepatitis, and only 1 lamivudine-treated patient had surface antibodies. Post-transplant survival in this small cohort was similar to that for all patients who underwent transplantation at our center during this time period.


CONCLUSIONS
Transplantation of hearts from donors with hepatitis-B core antibodies is associated with a small viral-transmission risk, with or without post-transplant, anti-viral prophylaxis. Use of these donor hearts should be considered safe and may help to augment the available donor pool.
Pinney
Sean P
SP
Division of Circulatory Physiology, New York Presbyterian Hospital, MHB5-435, 177 Fort Washington Avenue, New York, New York 10032, USA. sp461@columbia.edu
Cheema
Faisal H
FH
Hammond
Kimmarie
K
Chen
Jonathan M
JM
Edwards
Niloo M
NM
Mancini
Donna
D
D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009518:New York; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine