Lunel F, Cadranel J F, Rosenheim M, Dorent R, Di-Martino V, Payan C, Fretz C, Ghoussoub J J, Bernard B, Dumont B, Perrin M, Gandjbachkh I, Huraux J M, Stuyver L, Opolon P
Virologie, Centre Hospitals Universitaire Angers, Angers, France.
Gastroenterology. 2000 Oct;119(4):1064-74. doi: 10.1053/gast.2000.17951.
BACKGROUND & AIMS: We have observed a high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in heart transplant recipients (HTRs). The aim of this study was to assess the epidemiology, natural history, and clinical and biological characteristics of viral hepatitis in HTRs.
From 1983 to 1992, 874 patients underwent heart transplantation at the Pitié-Salpêtrière Hospital, Paris, France, 459 of whom qualified for analysis. A total of 140 patients had posttransplantation hepatitis B, C, or non-A-E. Sixty-nine patients developed HBV infection, 49 HCV infection, 11 HBV-HCV coinfection, and 11 non-A-E hepatitis.
HBV was transmitted nosocomially from patient to patient, most likely during endomyocardial biopsies. HCV was mainly transmitted through blood transfusions or the transplanted organ. Clinical and biological findings after 2 years of follow-up showed that 3 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 coinfected 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 coinfection, 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.
In our experience, histologic liver lesions do not progress rapidly in patients with post-heart transplant infection caused by HBV or HCV. HBV or HCV infection seems to have little impact on the 5-year survival rate of HTRs.
我们观察到心脏移植受者（HTRs）中乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染的高流行率。本研究的目的是评估HTRs中病毒性肝炎的流行病学、自然史以及临床和生物学特征。
1983年至1992年，874例患者在法国巴黎皮蒂-萨尔佩特里埃医院接受心脏移植，其中459例符合分析条件。共有140例患者发生移植后乙型、丙型或非甲-戊型肝炎。69例患者发生HBV感染，49例发生HCV感染，11例发生HBV-HCV合并感染，11例发生非甲-戊型肝炎。
HBV主要通过医院内患者之间传播，最有可能发生在心内膜心肌活检期间。HCV主要通过输血或移植器官传播。随访2年后的临床和生物学结果显示，3例HBV A基因型前核心突变患者发生了严重或亚暴发性肝炎，HBV和HCV感染患者均发展为慢性。一般来说，患者丙氨酸氨基转移酶水平轻度升高，病毒复制水平高，除前核心HBV突变体感染患者外，严重组织学病变较少。HBV和HCV合并感染患者的肝脏病变往往更严重。病毒性肝炎患者（HBV，81%；HCV；89%；HBV和HCV合并感染，100%；非甲-戊型肝炎，73%）移植后5年的生存率与肝功能检查无异常患者（76%）相似。有或无肝功能检查异常患者的精算生存曲线也相似。
根据我们的经验，心脏移植后由HBV或HCV感染引起的患者肝脏组织学病变进展并不迅速。HBV或HCV感染似乎对HTRs的5年生存率影响不大。
