Patient to patient hepatitis B transmission during heart biopsy procedures. A report of the European Working Party on Viral Hepatitis in Heart Transplant Recipients

Hepatitis B virus (HBV) is an hepatotropic DNA virus. Important routes of horizontal transmission of the virus are through blood or blood products, by sexual contact and by organ transplantation. After an acute infection, 5-10% of immunocompetent adult patients and 90-100% of patients on immunosuppressive therapy or who acquire HBV via vertical transmission will develop chronic hepatitis B. In general, heart transplant recipients are screened for the absence of HBsAg and anti-HBc before being accepted for transplantation. Organ donors, as well as blood donors, are screened for the absence of HBsAg before being accepted. However, we think that it is important to draw the attention of transplant cardiologists, thoracic surgeons, hepatologists and those involved in hospital infection control to the risk of nosocomial transmission of hepatitis B virus during endomyocardial biopsy procedures. Complete epidemiological data are now published from the Hannover group and have been submitted for publication from the Rotterdam and Paris groups. In Hannover hepatitis B was diagnosed in 67 patients in a five-year period (crude attack rate 27.5%). In Paris, 86 cases of HBV infection were diagnosed in an 11-year period (crude attack rate 11.5%). In Rotterdam, 21 cases were diagnosed in a 12-year period (crude attack rate 8.2%). Because this problem may be common to several heart-transplant units, our group has started a 'European Registry on Viral Hepatitis in Heart Transplant Recipients' to study the determinants of the outcome of the disease and to coordinate future interventions. We would welcome any centre that is willing to contribute their experience and collaborate with us.