Fagiuoli S, Minniti F, Pevere S, Farinati F, Burra P, Livi U, Naccarato R, Chiaramonte M
Department of Surgical and Gastroenterological Sciences,University of Padova, Padova, Italy.
J Heart Lung Transplant. 2001 Jul;20(7):718-24. doi: 10.1016/s1053-2498(01)00255-8.
Heart transplant (HTx) recipients risk acquiring hepatotropic viral infections such as hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of these infections on post-HTx survival remains unclear. The aim of the present study was to define the prevalence, clinical features, and natural history of HBV and HCV infections in a cohort of HTx recipients.
We retrospectively studied 360 consecutive patients who had undergone HTx. Clinical picture, hepatic injury indexes, and HBV/HCV viral serology were followed post-transplant.
During follow-up (average, 8 +/- 3.1 years), 49 (16.5%) of the HTx recipients tested positive for at least 1 of the 2 viruses (3.1% HBV, 12% HCV, 0.5% concomitant infection). The prevalence of HCV infection in heart transplant recipients transplanted before and after 1990 was 28% and 4.2%, respectively, the latter being markedly lower (p < 0.001) than in earlier series of HTx recipients and much lower than expected in the age- and sex-matched general population. All HBV-positive and 58% of HCV-positive recipients developed chronic liver disease. Sixteen percent of patients developed cirrhosis during follow-up, and 8% died of end-stage liver disease.
The prevalence of HBV and HCV in a large population of HTx recipients is not very different from that reported in the general population. Active viral replication of HBV and an aggressive natural history of both infections are seen in HTx recipients, however. The low prevalence of HBV- and HCV-related infection in recent series probably reflects current viral screening and vaccination policies.
心脏移植（HTx）受者有感染嗜肝病毒的风险，如乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV），而这些感染对心脏移植术后生存的影响尚不清楚。本研究的目的是确定一组心脏移植受者中HBV和HCV感染的患病率、临床特征及自然病程。
我们回顾性研究了360例连续接受心脏移植的患者。移植后随访临床症状、肝损伤指标及HBV/HCV病毒血清学情况。
在随访期间（平均8±3.1年），49例（16.5%）心脏移植受者至少对这两种病毒中的一种检测呈阳性（HBV 3.1%，HCV 12%，合并感染0.5%）。1990年前后接受心脏移植的受者中HCV感染患病率分别为28%和4.2%，后者明显低于早期心脏移植受者系列（p<0.001），且远低于年龄和性别匹配的普通人群预期患病率。所有HBV阳性和58%的HCV阳性受者发展为慢性肝病。随访期间16%的患者发展为肝硬化，8%死于终末期肝病。
大量心脏移植受者中HBV和HCV的患病率与普通人群报告的患病率没有太大差异。然而，在心脏移植受者中可观察到HBV的活跃病毒复制以及这两种感染的侵袭性自然病程。近期系列中HBV和HCV相关感染的低患病率可能反映了当前的病毒筛查和疫苗接种政策。
