Is there any risk of transmission of hepatitis B from heart donors hepatitis B core antibody positive?

Is There Any Risk of Transmission of Hepatitis B From Heart Donors Hepatitis B Core Antibody Positive? M. Blanes, D. Gomez, J. Cordoba, L. Almenar, M. Gobernado, J. Lopez-Aldeguer, and F. Dicenta

T

HE RISK of transmission of hepatitis B virus (HBV) from hepatitis B surface antigen (HBsAg) positive donors in organ transplant is well known. However, the possible risk of transmission from HBsAg negative and hepatitis B core antibody positive (HBcAb⫹) heart transplantation (HT) donors is presumably low and must be defined in clinical studies.1 This is an interesting issue to study due to the known high risk of hepatitis B transmission from HBcAb⫹ donors in liver transplantation2; the high prevalence of HBsAg⫹ in studies of heart transplantation3,4; the oligosymptomatic clinical course after de novo hepatitis B and the possibility of hepatitis B prophylaxis (lamivudine, immunoglobulins, vaccination) to prevent complications. PATIENTS AND METHODS From January 1995 to June 1999, 146 HT (5 heart–lung transplantations) were performed in our hospital. Recipients from donors HBcAb⫹ were clinically and serologically followed up. HBV DNA assays was performed both in serum and in lymphocytes in the last analytical follow up. Serologic assays for HBV markers were tested using commercially available enzyme-linked immunoassays (HBsAg, Abbott-ASXYM; HBcAb and HBsAb, Dia Sorin). HBV DNA assays were performed by nested PCR as previously described.5

RESULTS

All donors were HBsAg⫺. Prevalence of HBcAb⫹ in donors was 7.9% (11/139) and of HBsAc⫹ 26.1% (34/130). HBV

DNA was negative in all HBcAb⫹ donors. Neither serologic nor clinical hepatitis B was found in the follow up of the 11 cases at risk. There were not any changes in the serologic pretransplant pattern of the seven patients who survived more than a year (mean follow up of 37.7 months) (Table 1). Mortality was not related to hepatitis B. HBV DNA was negative in all the serum samples and only one recipient had positive lymphocytes. DISCUSSION

There is scarce information about transmission of hepatitis B from HBcAb⫹ heart donors.1 To know the risk of transmission of hepatitis B using such donors, we need studies with a higher number of patients and longer follow up. Nevertheless, in the light of these results, we could suggest that should the risk must be low. We have found neither clinical nor serologic consequences in the short-tomedium term. The clinical significance of a single recipient with HBV DNA in peripheral blood lymphocytes (but not in serum) is unknown.

From the Infectious Diseases Unit (M.B., J.L.A.), Department of Microbiology (D.G., J.C., M.G.), and the Department of Cardiology (L.A., F.D.), University Hospital la Fe, Valencia, Spain. Address reprint requests to M. Blanes Julia´, MD, c/Mestre Ripoll No 9 Ex: lzq Pt 22, 46.022 Valencia, Spain.

Table 1. Serologic and Virologic Follow-Up of Patients Receiving Allografts From HBcAbⴙ Donors Pre-TC Serology

Post-TC Serology

HBV DNA

Case

HBcAc

HBsAs

HBcAc

HBsAs

Serum

Lymph

1 2 3 4 5 6 7 8 9 10 11

NEG NEG NEG NEG POS NEG POS NEG POS NEG POS

NEG NEG NEG — NEG NEG POS NEG POS NEG POS

NEG NEG NEG NEG POS NEG POS NEG

NEG NEG NEG NEG NEG NEG POS NEG

NEG NEG NEG NEG NEG NEG

NEG NEG POS NEG NEG NEG

NEG

NEG

HBsAg⫺

© 2002 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 34, 61–62 (2002)

Death/Cause

Month 5/bronchopneumia Day 34/Aspergillosis Month 6/rejection Day 33/bronchopneumia

0041-1345/02/$–see front matter PII S0041-1345(01)02666-5 61

62

REFERENCES 1. Wachs ME, Amend WJ, Ascher NL, et al: Transplantation 59:230, 1995 2. Dickson RC, Everhart JE, Lake JR, et al: Gastroenterology 113:1668, 1997

BLANES, GOMEZ, CORDOBA ET AL 3. Cadranel JF, Lunel F, Perrin M, et al: Gastroenterol Clin Biol 16:671, 1992 4. Wedemeyer H, Pethig K, Wagner D, et al: Transplantation 66:1347, 1998 5. Baker BL, Di Bisceglie AM, Kaneko S, et al: Hepatology 13:632, 1991