Hepatitis B in Heart Transplant Donors and Recipients: A Systematic Review and Meta-Analysis

Introduction: Expanding the heart donor pool to include patients with hepatitis B virus (HBV) could help ameliorate the organ shortage in heart transplantation. We performed a sys-tematic review and meta-analysis to evaluate the management and recipient outcomes of D+/R-and D-/R+ heart transplants. Methods: An electronic search was performed to identify all relevant studies published on heart transplants involving HBV+ donors and/or HBV+ recipients. A comparison was per-formed between two groups where heart transplants were performed a) D+/R-(n = 98) versus b) D-/R+ (n = 65). Results: Overall, 13 studies were selected, comprising 163 patients. Mean patient age was 55 y (95% CI: 39, 78) and 79% (69, 86) were male. Active post-transplant HBV infection requiring antiviral treatment occurred in 11% (1, 69) of D+/R-recipients and 33% (9, 71) of D-/R+ recipients. Post-transplant antiviral therapy was given to 80% (6, 100) of D+/R-recipients compared to 72% (42, 90) of D-/R+ recipients (P = 0.84). Hepatitis-related mor-tality was observed in no D+/R-recipients and 7% (2, 27) of D-/R+ recipients. Survival 1-y post-transplant was comparable between both groups at 83% (83, 92) and 81% (61, 92) for D+/R-and D-/R+ transplants, respectively. Conclusions: Our review found that HBV D+/R-heart transplantation was associated with fewer active hepatitis infections and lower hepatitis-related mortality than D-/R+ trans-plantation, with comparable survival at 1 y. Additional studies utilizing HBV nucleic acid testing (NAT) to compare outcomes with HBsAg+ and anti-HBc+ donors are crucial to reach more definitive conclusions about the risk of donor-derived infections in this context.(c) 2022 Elsevier Inc. All rights reserved.