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Background: Hepatitis B surface antigenemia (HBsAg) has been considered at least a relative contraindication for heart transplantation, yet patients have undergone liver transplantation for hepatitis B-induced chronic liver disease, albeit with poorer results than for other liver diseases. The impact of asymptomatic hepatitis B infection on heart transplant outcome is not known., Methods: To examine this question, we queried the Joint International Society for Heart and Lung Transplantation/United Network of Organ Sharing Thoracic Registry for all patients undergoing heart transplantation who had been identified as positive for HBsAg before transplantation. We then sent a 4-question data instrument to the centers responsible for the identified patients. Seventy-eight patients were identified. Of the 78 data forms sent, 53 forms were returned with the requested data. Of the 53 data forms returned, the centers incorrectly identified 23 patients as positive for HBsAg, resulting in 30 patients who were confirmed as HBsAg positive and who served as the final cohort for this analysis., Results: The cohort included 24 males and 6 females, with a mean age of 46 +/- 16 years (range 0 to 68 years). Eleven patients had coronary artery disease, 14 had dilated cardiomyopathy, and 5 patients had a variety of other cardiac diseases. Of those tested at most recent follow-up, 20 of 25 patients continued to be positive for HBsAg, whereas 7 of 21 patients studied had converted and were hepatitis B serum antibody-positive. Approximately 37% of the patients had evidence of active hepatic inflammation or cirrhosis. We found a statistically significant correlation between positivity for hepatitis C antibodies and clinical liver disease (p = 0.0105). No difference in survival could be demonstrated between the study cohort and a reference heart transplant cohort, yet 5 of the 9 deaths were considered to be related to hepatitis B., Conclusions: These data demonstrate that clinical liver disease is common post-transplantation in HBsAg+ patients who presumably have no overt liver disease at the time of transplantation. Despite the inability to show a survival difference in this cohort, the fact that the majority of deaths were related to hepatitis B should suggest caution in accepting HBsAg+ patients for cardiac transplantation.

Background: The morbidity and mortality studies on heart transplantation to date have come from single-center or multicenter studies that often have required collection of data over periods of time greater than a year. Data are now available from the International Society for Heart and Lung Transplantation/United Network for Organ Sharing (ISHLT/UNOS) Thoracic Registry from all centers in the United States performing heart transplantation, which allows analysis of morbidity and mortality rates on an annual basis., Methods: All transplantation centers in the United States are now required to submit registration (at the time of transplantation) and 1-year follow-up clinical data on all heart transplant recipients to the ISHLT/UNOS Thoracic Registry. Data forms were submitted to the Registry regarding pretransplantation diagnoses, causes of death, rehospitalization, functional and work status at 1 year, immunosuppressive therapy, and the development of complications such as hypertension, hyperlipidemia, renal insufficiency, diabetes, and malignancy. This study is an analysis of this database for the period of April 1, 1994, through March 31, 1995, examining specifically morbidity, functional status, and other clinical events occurring during the period after the initial hospitalization and up to the first-year follow-up. The study cohort consisted of the 1853 patients who survived the initial hospitalization and for whom matching registration and 1-year follow-up forms were available., Results: Rehospitalization during the first year after the initial admission was required by more than 40% of survivors, and at least one third of these required admission to the intensive care unit. Infection and rejection were the most common reasons for rehospitalization, each accounting for about 20%. Complications during the first year occurring in 10% or more of survivors included hypertension, diabetes, renal dysfunction, and hyperlipidemia. Less common complications included symptomatic bone disease, chronic liver disease, cataracts, stroke, and malignancy. Allograft function was excellent among survivors at 1 year, with a mean ejection fraction of 57.4% and less than 7% of patients requiring pacemaker therapy or having development of coronary artery disease. Eighty-three percent of survivors reported no functional limitations, but only 27% were working full-time. Eighty-nine percent of survivors were receiving prednisone at their 1-year follow-up., Conclusion: Clinical data are now available from the ISHLT/UNOS Thoracic Registry on the basis of the initial registration and 1-year follow-up of all patients undergoing heart transplantation in the United States. Analysis of these data from April 1, 1994, through March 31, 1995, demonstrates that the first year after the initial hospitalization for heart transplantation is a period of significant morbidity and frequent rehospitalization but excellent survival. In spite of a high level of functional capacity at 1-year follow-up, only a minority of patients return to work. The ISHLT/UNOS Thoracic Registry can now serve as a valid source of data for future analysis of trends in heart transplantation in the United States.