The impact of hepatitis B on heart transplantation: 19 years of national experience in Korea.
BACKGROUND
Hepatitis B virus (HBV) infection is endemic in Korea. With an increasing number of heart transplantation, problems associated with hepatitis B reactivation are becoming an important issue. We aimed to evaluate the functional significance of HBV infection on outcomes of heart transplantation.


METHODS
We reviewed all medical records of overall national heart transplantation recipients and donors who had HBV hepatitis at the time of the transplantation, from March 1994 to May 2013. We investigated the HBV serology status, HBV-DNA level of donors and recipients, liver function test, immunosuppressive agent and antiviral agent prescription, and hepatitis morbidity and mortality.


RESULTS
1) There were 12 HBsAg (+) recipients and 6 HBsAg (+) donors. Median duration of follow-up was 1715 days (minimum 162 days to maximum 6553 days). 2) Nine HBsAg (+) recipients (75%), who continued antiviral treatment, have survived without any hepatic event. Reactivation of HBV developed in 3 recipients at a median duration of 238 days after transplantation. They died of fulminant hepatitis despite antiviral rescue therapy. 3) In contrast, 6 recipients with immunity to HBV before the transplantation, who had received heart from HBV (+) donors, have survived without any liver-related event.


CONCLUSIONS
HBV (+) recipients have perioperative results and long-term survival rates comparable to HBV (-) recipients. However, absence or cessation of antiviral prophylaxis indiscriminately brought reactivation of HBV, which rapidly progressed to hepatic failure and death. In contrast, HBV (+) hearts transplanted to HBV-immune recipients were maintained without hepatitis reactivation. Nineteen years of national experience strongly suggests that long-term antiviral prophylaxis is necessary for HBV (+) recipients.
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Hyo-Sun
HS
Shin
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Hyun-Jai
HJ
Cho
Department of Cardiology, Samsung Medical Center, Seoul, Korea.
Eun-Seok
ES
Jeon
Seoul National University Hospital Transplantation Center, Seoul, Korea.
Ho Young
HY
Hwang
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Jae-Joong
JJ
Kim
Seoul National University Hospital Transplantation Center, Seoul, Korea.
Ki-Bong
KB
Kim
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Byung-Hee
BH
Oh
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Hae-Young
HY
Lee
D000328:Adult; D000368:Aged; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000401:mortality* / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009025:Morpholines; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D014775:Virus Activation
D006514:Hepatitis B Surface Antigens; D009025:Morpholines; C071738:2-(4-morpholino)ethyl-1-phenylcyclohexane-1-carboxylate