Heart transplantation in patients with chronic hepatitis B: clinical evolution, molecular analysis, and effect of treatment.
We evaluated clinical evolution and hepatitis B virus (HBV) molecular changes in heart recipients with chronic HBV infection before transplantation, and studied the effects of lamivudine treatment in patients who experienced HBV reactivation. Nine patients with chronic HBV infection who underwent heart transplantation were investigated. HBV surface/core-promoter/precore/core regions were sequenced. Prior to transplantation, all nine patients had consistently normal ALT and low HBV-DNA levels. Seven experienced HBV reactivation after transplantation (ALT elevated, HBV-DNA>200.000 cps/ml). Lamivudine treatment was initially effective in all patients; three patients during the second year of treatment developed lamivudine resistance-associated mutations (rt-L180M, rt-M204V) with severe disease reactivation, remitted after switch to adefovir treatment. No other significant HBV mutations were identified in the genomic regions studied. Immune suppression is crucial in the reactivation of previous inactive HBV infection and in the liver disease progression in heart recipients. Preemptive lamivudine treatment could be useful in the early management of these patients.
Zampino
Rosa
R
Internal Medicine and Hepatology, Second University of Naples, and Unit of Infectious and Transplant Medicine Monaldi Hospital, Italy. rosa.zampino@unina2.it
Marrone
Aldo
A
Ragone
Enrico
E
Costagliola
Loredana
L
Cirillo
Grazia
G
Karayiannis
Peter
P
Ruggiero
Giuseppe
G
Utili
Riccardo
R
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D024882:Drug Resistance, Viral; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery*; D016027:Heart Transplantation; D006512:Hepatitis B Core Antigens / Q000235:genetics; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000235:genetics / Q000378:metabolism / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D011184:Postoperative Period; D011401:Promoter Regions, Genetic; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D014775:Virus Activation
D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C053001:adefovir; D000410:Alanine Transaminase; D000225:Adenine