TRANSMISSION OF HEPATITIS-C VIRUS BY A CARDIAC-SURGEON

Background. In the course of a study conducted from 1992 through 1994 of the efficacy of screening blood donors for antibodies to hepatitis C virus (HCV), we found that two patients had acquired hepatitis C aft er cardiac surgery, with the transmission apparently unrelated to bloo d transfusions, Because their surgeon had chronic hepatitis C, we soug ht to determine whether he was transmitting the virus to his patients. Methods. Of 222 of the surgeon's patients who participated in studies of post-transfusion hepatitis between 1988 and 1994, 6 contracted pos toperative hepatitis C, despite the use of only seronegative blood for transfusions, All six patients had undergone valve-replacement surger y, Analyses were performed to compare nucleotide sequences encompassin g the hypervariable region at the junction between the coding regions for envelope glycoproteins E1 and E2 in the surgeon, the patients, and 10 controls infected with the same HCV genotype. Results. The surgeon and five of the six patients with hepatitis C unrelated to transfusio n were infected with HCV genotype 3; the sixth patient had genotype 1 and was considered to have been infected from another source, Thirteen other patients of the surgeon had transfusion associated hepatitis C and were also infected with genotype 1. The average net genetic distan ce between the sequences from the five patients with HCV genotype 3 an d those from the surgeon was 2.1 percent (range, 1.1 to 2.5 percent; P <0,001), as compared with an average distance of 7.6 percent (range, 6 .1 to 8.3 percent) between the sequences from the patients and those f rom the controls, The results of a phylogenetic-tree analysis indicate d a common epidemiologic origin of the viruses from the surgeon and th e five patients. Conclusions. Our findings provide evidence that a car diac surgeon with chronic hepatitis C may have transmitted HCV to five of his patients during open-heart surgery.