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

Colin C. Yost, Diana C. Jimenez, Matthew P. Weber, Elizabeth J. Maynes, Katherine A. Belden, Vakhtang Tchantchaleishvili, H. Todd Massey, David A. Sass, J. Eduardo Rame, John J. Zurlo, Nana Aburjania*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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 systematic 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 performed 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 mortality 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+ transplantation, 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.

Original languageEnglish
Pages (from-to)1078-1090
Number of pages13
JournalJournal of Surgical Research
StatePublished - Mar 2023
Externally publishedYes


  • Donor pool expansion
  • Donor-derived infections
  • Heart transplantation
  • Hepatitis B


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