TY - JOUR
T1 - Heart transplantation in patients with chronic hepatitis B
T2 - Clinical evolution, molecular analysis, and effect of treatment
AU - Zampino, Rosa
AU - Marrone, Aldo
AU - Ragone, Enrico
AU - Costagliola, Loredana
AU - Cirillo, Grazia
AU - Karayiannis, Peter
AU - Ruggiero, Giuseppe
AU - Utili, Riccardo
PY - 2005/11
Y1 - 2005/11
N2 - 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.
AB - 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.
KW - Heart transplant
KW - Hepatitis B reactivation
KW - Hepatitis B virus mutations
KW - Lamivudine
UR - http://www.scopus.com/inward/record.url?scp=28544444280&partnerID=8YFLogxK
U2 - 10.1097/01.tp.0000176941.21438.95
DO - 10.1097/01.tp.0000176941.21438.95
M3 - Article
C2 - 16314804
AN - SCOPUS:28544444280
SN - 0041-1337
VL - 80
SP - 1340
EP - 1343
JO - Transplantation
JF - Transplantation
IS - 9
ER -