EPIDEMIOLOGY AND NATURAL-HISTORY OF HEPATITIS-C INFECTIONS IN LIVER-TRANSPLANT RECIPIENTS

Hepatitis C infection is common in patients undergoing liver transplan tation. Few studies have focused on the prevalence and epidemiology of hepatitis C infection among liver transplant recipients since the imp lementation of donor screening for antibodies against the hepatitis C virus (anti-HCV). Using reverse transcription-polymerase chain reactio n (RT-PCR) and genomic sequencing methods, we sought to determine the prevalence, epidemiology, and natural history of hepatitis C infection s among 44 consecutive liver transplant patients between January and D ecember 1991. All patients and donors were screened for antibodies aga inst HCV with a first-generation test. Laboratory tests and liver biop sies were routinely done 12 months after transplantation. Serum sample s from all organ donors and transplant recipients were analyzed for th e presence of HCV-RNA. From four of the six HCV-RNA-positive patients, pre- and post-transplant serum samples were available for sequence an alysis. No donor had detectable HCV-RNA. Six of 44 (13.6%) patients ha d detectable HCV-RNA before and after liver transplantation. Recurrent infection was documented in all who were infected before transplantat ion and was confirmed by genotype analysis in the four patients who we re analyzed. No acquired infections were identified. After transplanta tion, the HCV-RNA-positive recipients had higher mean alanine aminotra nsferase (207 +/- 85 U/l vs 37 +/- 7 U/l; p<0.0001) and were more like ly to have chronic hepatitis (50% vs 6%; p<0.03) than the HCV-RNA-nega tive recipients. We conclude that hepatitis C infections are not uncom mon in the setting of liver transplantation, recurrent infections are practically universal after transplantation, and when donors are scree ned for antibodies against HCV, acquired infections are rare. The hist ologic changes associated with hepatitis C infections in liver transpl ant recipients are variable but tend to be mild. Future studies must a ssess the long-term effects of hepatitis C in liver transplant recipie nts and establish the appropriate use of organs from donors with detec table antibodies against HCV. (C) Journal of Hepatology.