Heart Retransplantation from an Anti-HBcore Positive Donor.

The number of transplantations from an anti-HBcore positive donor to a seronegative recipient is still low. We present the first documented case in the history of the Silesian Center for Heart Diseases in Zabrze of a successful retransplantation from an HBcAb (+) donor to a seronegative recipient. A 45-year-old male patient after HTX in 2014 due to NICM was admitted with the signs and symptoms of heart failure. Severe mitral and tricuspid regurgitation and impaired systolic function of the graft were observed (LVEF 25%, RV hypokinesis). Vasculopathy was excluded, endomyocardial biopsy revealed no signs of acute cellular rejection (ACR 0). Due to the further deterioration, a decision of urgent heart retransplantation was made. A suitable donor with positive HBcAb antibodies and a negative HBs antigen was reported. After obtaining written informed consent, urgent orthotopic heart retransplantation was performed. The patient was vaccinated against hepatitis B, but the level of antibodies was undetectable. Pre-transplantation prophylaxis with lamivudine combined with subsequent valgancyclovir CMV prophylaxis was made. Active inflammatory cardiomyopathy of the explanted heart was diagnosed (histological examination). Inflammation of the transplanted heart was present despite no signs of cellular rejection in the endomyocardial biopsy. After the retransplantation signs of ACR in the 3a class were observed twice in the two first biopsies. High levels of GGTP (max. 692 U/l) and ALP (max. 214 U/l) were found in the second month after the transplantation. Transaminase and bilirubin levels were normal, abdominal US showed no pathology. The results improved in the follow-up. No manifestation of ACR and normal graft function were observed. After three months, valganciclovir prophylaxis was completed. The patient still received lamivudine (up to one year). In the repeated assessments, negative HBs antigen and low anti-HBs titers were found. We present a case report of heart retransplantation due to graft failure from an anti-HBcore positive and HBs antigen negative donor to a seronegative recipient. Based on anatomopathological and histopathological examination of the explanted graft, we also suggest that acute cellular rejection in the transplanted heart may exist despite negative findings in right-sided endomyocardial biopsy. [ABSTRACT FROM AUTHOR]