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 Printable version |
Focus on hepatitis B or C for heart transplant donors or candidate recipients |
Hépato-Gastro. Volume 16, Number 3, 183-9, mai-juin 2009, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Pascal Lebray, Dominique Thabut, Shaïda Varnous |
Summary : The possibility since December 2005 of obtaining under special dispensation grafts from donors with markers of previous infection with hepatitis B virus, or hepatitis C virus, is an interesting option in patients who require a heart transplant and whose prognosis is life-threatening. The long-term risks of this new strategy are currently being assessed, but the high prevalence of cases of de novo contamination in the early 1990s enabled a clearer understanding of the prognosis for viral hepatitis B and C in the setting of heart transplantation. Although simple prophylactic measures have limited the risk of de novo infection, transplants in contaminated recipients are set to increase in France with the increasing prevalence but better control of hepatitis B and C infections. It is therefore necessary to improve pre-transplant assessment techniques in order to detect advanced liver fibrosis in the recipient and to discuss the pertinence of a heart graft only. After surgery and whether, the viral infection is de novo or occurred in the past, there remains a small risk of fulminant or subfulminant development as cholestatic liver fibrosis. More frequently, the situation evolves towards cirrhosis and its complications. Thus in the long term, excess liver-related mortality is observed. As far as treatment is concerned, nucleos(t)idic analogues are effective against hepatitis B infection and anti-HBs immunoglobulins can prevent any risk of reactivation in case of a high-risk donor (positive anti-HBc antibodies). In HCV-infected subjects, the absolute contraindication of interferon and the lack of therapeutic efficacy will remain problematic until new therapies become available. For all these reasons, multidisciplinary collaboration is mandatory in this setting. |
Keywords : heart transplantation, HBV, HCV, antibody anti-HBc |
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