Heart transplantation in patients with chronic hepatitis B: Clinical evolution, molecular analysis, and effect of treatment

Rosa Zampino, Aldo Marrone, Enrico Ragone, Loredana Costagliola, Grazia Cirillo, Peter Karayiannis, Giuseppe Ruggiero, Riccardo Utili

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1340-1343
Number of pages4
JournalTransplantation
Volume80
Issue number9
DOIs
Publication statusPublished - Nov 2005

Keywords

  • Heart transplant
  • Hepatitis B reactivation
  • Hepatitis B virus mutations
  • Lamivudine

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