%0 Journal Article
%T Should We Consider Patients with Coexistent Hepatitis B or C Infection for Orthotopic Heart Transplantation?
%A Baskar Sekar
%A Pippa J. Newton
%A Simon G. Williams
%A Steven M. Shaw
%J Journal of Transplantation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/748578
%X Heart transplantation (HTX) is the gold standard surgical treatment for patients with advanced heart failure. The prevalence of hepatitis B and hepatitis C infection in HTX recipients is over 10%. Despite its increased prevalence, the long-term outcome in this cohort is still not clear. There is a reluctance to place these patients on transplant waiting list given the increased incidence of viral reactivation and chronic liver disease after transplant. The emergence of new antiviral therapies to treat this cohort seems promising but their long-term outcome is yet to be established. The aim of this paper is to review the literature and explore whether it is justifiable to list advanced heart failure patients with coexistent hepatitis B/C infection for HTX. 1. Introduction Heart transplantation (HTX) is the gold standard surgical treatment for patients with advanced heart failure. Worldwide, the median survival in patients who survive the first year after HTX is about 14 years [1]. This has been attributed to advances in immunosuppressive therapy over the years and importantly, the proper selection of patients who will benefit most from this treatment. Patients undergo extensive investigations from routine biochemistry and virology screening to invasive investigations like right heart catheterisation before being considered for heart transplantation. Patients with significant abnormalities from the assessment are deferred treatment. Though previous infection with Cytomegalovirus and Epstein-Barr virus is not an absolute contraindication, reactivation of these viruses after transplant due to immunosuppression can adversely affect long-term outcome [2, 3]. Hepatotropic viruses (especially hepatitis B and hepatitis C) affect a large number of people throughout the world and they are one of the commonest causes for chronic liver disease and hepatocellular carcinoma [4]. Worldwide, it is estimated that 2 billion people have been infected with hepatitis B and 150 million with hepatitis C. Around 600,000 and 250,000 individuals die each year of complications associated with hepatitis B and hepatitis C infections, respectively. The prevalence of hepatitis B and hepatitis C infection in HTX population is over 10% [5]. Despite its increased prevalence, the long-term outcome in this particular cohort is still not clear. There is no clear consensus as to whether patients with coexistent hepatitis B or C infection, including individuals with a past history of acute resolved infection, should be considered for HTX. The aim of this paper is to review the literature and
%U http://www.hindawi.com/journals/jtrans/2013/748578/