title: Twenty-four year single-center experience of hepatitis B virus infection in heart transplantation.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) infection is hyperendemic in Taiwan. We have reported the outcome of (1) recipients with hepatitis B surface antigen (HBsAg)-positive; HBsAg-negative recipients who receive donor hearts from HBsAg-positive donors; and treatment with lamivudine of hepatitis B flare-ups after heart transplantation, using case numbers that range from 100 to 200.
  
  
  METHODS
  From July 1987 to May 2011, all 412 orthotopic heart transplant recipients and donors underwent routine preoperative screening for hepatitis B virus markers and liver function parameters. Lamivudine was prescribed prophylactically for recipients with elevated serum enzyme levels or an HBV DNA virus load before transplantation, or when there was evidence of hepatitis B flare-up after transplantation. Postoperative HBV markers and liver function parameters were collected over a mean follow-up time of 7.8 years.
  
  
  RESULTS
  Thirty-four recipients were HBsAg-positive before heart transplantation, and 23 experiencing HBV reactivation upon follow-up requiring lamivudine treatment. Clinical responses were achieved in all of them: 15 were complete and two, slow partial responses. Twenty-six recipients with an HBV naïve status at the time of heart transplantation, and three patients received donor hearts from an HBsAg-positive donor under perioperative hepatitis B immunoglobulin prophylaxis. HBV infection was successfully prevented in two patients, but the other one contracted HBV hepatitis, which was successfully treated with lamivudine.
  
  
  CONCLUSIONS
  HBV reactivation after the heart transplantation was common but usually well controlled with lamivudine treatment. Although posttransplantation liver function deteriorated for a period, there was no HBV infection-related morbidity or mortality. Perioperative hepatitis B immunoglobulin prophylaxis can successfully prevent HBV naïve recipients from infection in some cases, but HBsAg-positive donors should only be considered in high risk situations.
authors.affiliation: Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
authors.forename: Y C
authors.initials: YC
authors.lastname: Chen
authors.forename: M K
authors.initials: MK
authors.lastname: Chuang
authors.forename: N K
authors.initials: NK
authors.lastname: Chou
authors.forename: N H
authors.initials: NH
authors.lastname: Chi
authors.forename: I H
authors.initials: IH
authors.lastname: Wu
authors.forename: Y S
authors.initials: YS
authors.lastname: Chen
authors.forename: H Y
authors.initials: HY
authors.lastname: Yu
authors.forename: S C
authors.initials: SC
authors.lastname: Huang
authors.forename: C H
authors.initials: CH
authors.lastname: Wang
authors.forename: C I
authors.initials: CI
authors.lastname: Tsao
authors.forename: W J
authors.initials: WJ
authors.lastname: Ko
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D004279:DNA, Viral / Q000097:blood; D046148:Donor Selection; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D019259:Lamivudine; D000410:Alanine Transaminase; C045213:hepatitis B hyperimmune globulin