Hepatitis B in Heart Transplant Donors and Recipients: A Systematic Review and Meta-Analysis.

Abstract

INTRODUCTION:

Expanding the heart donor pool to include patients with hepatitis B virus (HBV) could help ameliorate the organ shortage in heart transplantation. We performed a systematic review and meta-analysis to evaluate the management and recipient outcomes of D+/R- and D-/R+ heart transplants.

METHODS:

An electronic search was performed to identify all relevant studies published on heart transplants involving HBV+ donors and/or HBV+ recipients. A comparison was performed between two groups where heart transplants were performed a) D+/R- (n = 98) versus b) D-/R+ (n = 65).

RESULTS:

Overall, 13 studies were selected, comprising 163 patients. Mean patient age was 55 y (95% CI: 39, 78) and 79% (69, 86) were male. Active post-transplant HBV infection requiring antiviral treatment occurred in 11% (1, 69) of D+/R- recipients and 33% (9, 71) of D-/R+ recipients. Post-transplant antiviral therapy was given to 80% (6, 100) of D+/R- recipients compared to 72% (42, 90) of D-/R+ recipients (P = 0.84). Hepatitis-related mortality was observed in no D+/R- recipients and 7% (2, 27) of D-/R+ recipients. Survival 1-y post-transplant was comparable between both groups at 83% (83, 92) and 81% (61, 92) for D+/R- and D-/R+ transplants, respectively.

CONCLUSIONS:

Our review found that HBV D+/R- heart transplantation was associated with fewer active hepatitis infections and lower hepatitis-related mortality than D-/R+ transplantation, with comparable survival at 1 y. Additional studies utilizing HBV nucleic acid testing (NAT) to compare outcomes with HBsAg+ and anti-HBc+ donors are crucial to reach more definitive conclusions about the risk of donor-derived infections in this context.

• Authors: Colin C Yost, Diana C Jimenez, Matthew P Weber, Elizabeth J Maynes, Katherine A Belden, Vakhtang Tchantchaleishvili, H Todd Massey, David A Sass, J Eduardo Rame, John J Zurlo, Nana Aburjania
• Journal: The Journal of surgical research (J Surg Res) Vol. 283 Pg. 1078-1090 (03 2023) ISSN: 1095-8673 [Electronic] United States
• PMID: 36914999 (Publication Type: Meta-Analysis, Systematic Review, Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Antiviral Agents
• Hepatitis B Antibodies
• Hepatitis B Core Antigens

Topics

• Humans
• Male
• Female
• Hepatitis B (epidemiology, drug therapy)
• Hepatitis B virus
• Heart Transplantation (adverse effects)
• Antiviral Agents (therapeutic use)
• Hepatitis B Antibodies (therapeutic use)
• Tissue Donors
• Hepatitis B Core Antigens (therapeutic use)
• Retrospective Studies