Hepatitis B Virus Reactivation after Heart Transplant: Incidence and Clinical Impact

Background: Occult hepatitis B infection consists of persistence of HBV genomes in hepatocytes, absence of serum HBsAg, low/undetectable serum HBVDNA. Reactivation of HBV infection may occur during immunosuppression, but few data are available in heart transplant. Objectives: We followed-up heart recipients with or without markers of previous HBV infection, evaluating prevalence of HBV markers, incidence of HBV reactivation and its virological and clinical features. Study design: Heart failure patients listed for heart transplant (2007-2013) were screened for current or past HBV infection. Transplanted patients with past HBV infection (anti-HBc +/+/- anti-HBs +/HBVDNA-) were followed up as cases, and an equal number of HBV negative patients as controls. Virological reactivation was detected by standard real-time and home-made highly sensitive PCR (surface/core HBVDNA regions). Clinical status and progression were assessed by liver histology, ultrasound or elastography. Results: 67 patients underwent heart transplant, including 4 (5.9%) HBsAg + subjects. Cases were 11/67 (16.4%). During a median follow-up of 30 months, only one of these 11 patients presented viral reactivation (HBVDNA 209 IU/mL) at month 22, and started antiviral treatment. Four other recipients showed virological events of uncertain significance (sensitive PCR-only intermittently positive). Clinical signs of liver disease were observed in only one case at the last follow-up. A nonsignificant difference in survival was observed between cases and all other heart recipients without prior HBV contact (death rate 5/11 vs 15/52, respectively; p = 0.097). Conclusions: HBV genotypic reactivation in HBsAg-/anti-HBc+/HBVDNA-heart recipients is uncommon. Virological events of uncertain significance occur more frequently; their clinical impact seems to be negligible.