Can donors with prior hepatitis be safely used for heart transplantation?
BACKGROUND
Heart transplantation represents a significant life-saving and increased quality-of-life intervention for patients with refractory cardiac failure. Successful transplantation requires continuous immunosuppression to avoid immune rejection. Unfortunately, persistent viral infections in donors may be transmitted to recipients in the process of heart transplantation. With the severe shortage of available organs and significant waiting list mortality there is a rationale for considering use of organs from donors with evidence of prior hepatitis B and/or hepatitis C infection.


METHODS
Published literature articles were searched using Medline, PaperChase and further review of references in relevant articles on issues related to hepatitis B and hepatitis C and heart transplantation.


RESULTS
Donor and recipient testing for hepatitis B and hepatitis C is important for relative risk assessment. Nucleic acid testing for hepatitis B DNA and hepatitis C RNA represent emerging technologies, which may add valuable information to traditional serologic testing.


CONCLUSIONS
Heart transplant recipient risk may be modified by vaccination against hepatitis B before transplantation. There is currently no available vaccine for hepatitis C. Recently described effective treatments for hepatitis B and hepatitis C provide further rationale for reconsideration of using hearts from donors with evidence of hepatitis B and/or hepatitis C infection.
Mawhorter
Steven D
SD
Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. mawhors@ccf.org
Avery
Robin K
RK
D016027:Heart Transplantation / Q000009:adverse effects*; D006509:Hepatitis B / Q000635:transmission* / Q000821:virology; D006526:Hepatitis C / Q000635:transmission* / Q000821:virology; D006801:Humans; D008499:Medical Records; D012306:Risk; D014019:Tissue Donors