From 1983 to 1992, a multidisciplinary team analyzed 459 of the patients who underwent heart transplantation at the Pitié-Salpêtrière Hospital, Paris, France. A total of 140 patients had post-transplantation hepatitis B, C, or non-A-E. 69 patients developed HBV infection, 49 HCV infection, 11 HBV-HCV co-infection, and 11 non-A-E hepatitis.
They found that HBV was transmitted nosocomially from patient to patient, most likely during endomyocardial biopsies, but HCV was mainly transmitted through blood transfusions or the transplanted organ.
Clinical and biological findings after 2 years of follow-up showed that three patients with an HBV genotype A precore mutant had severe or subfulminant hepatitis, and that patients with HBV and HCV infection always progressed to chronicity.
In general, patients had mild alanine aminotransferase level increases, a high level of viral replication, and few severe histologic lesions, except for patients infected by precore HBV mutants.
Patients co-infected by HBV and HCV tended to have more severe liver lesions.
The survival rate 5 years after transplantation in patients with viral hepatitis (HBV, 81%; HCV, 89%; HBV and HCV co-infection, 100%; non-A-E hepatitis, 73%) was similar to that in patients without liver test abnormalities (76%). The actuarial survival curve was also similar in patients with or without liver test abnormalities.
5-year heart-transplantation survival similar, with or without liver test abnormalities.
"In our experience, histologic liver lesions do not progress rapidly in patients with post-heart transplant infection caused by HBV or HCV." concluded Francoise Lunel on behalf of the researchers.