PREVALENCE AND OUTCOME OF HEPATITIS-C INFECTION AMONG HEART-TRANSPLANT RECIPIENTS

Background: Hepatitis C virus infection is common in organ transplant recipients, and can be associated with significant morbidity and morta lity. A unique feature of this infection among immunosuppressed patien ts is that it can progress without the development of hepatitis C viru s antibodies. Methods: To define the prevalence of hepatitis C virus i nfection in patients undergoing heart transplantation and identify cli nical syndromes associated with hepatitis C virus infection in heart t ransplant recipients, we collected sera from 59 consecutive heart tran splant recipients and their donors. Samples were tested before and aft er transplantation for hepatitis C virus antibodies with the use of a second-generation recombinant immunoblot assay and for hepatitis C vir us RNA by means of reverse transcriptase polymerase chain reaction. Re sults: Four of 59 patients (7%) had hepatitis C virus-RNA detected in posttransplantation serum samples; but only one of these was anti-hepa titis C virus antibody positive. Two of the four patients with hepatit is C virus RNA detected after transplantation received organs from don ors who were positive for hepatitis C virus RNA/anti-hepatitis C virus . One of these two recipients tested positive for hepatitis C virus an tibody and hepatitis C virus RNA before transplantation. The other two patients received organs from hepatitis C virus negative donors and p ossibly acquired infection after transplantation from blood or immunog lobulin preparations. One patient was anti-hepatitis C virus positive before transplantation but had no detectable hepatitis C virus RNA, an d hepatitis C virus infection did not develop after transplantation. P rogressive hepatitis C virus-induced cholestatic liver disease that le d to hepatic failure and death after heart transplantation occurred in one of the four patients. Conclusion: Hepatitis C virus infection may occur after heart transplantation in the absence of antihepatitis C v irus antibodies, and a syndrome of severe cholestatic liver disease ma y complicate heart transplantation in the presence of hepatitis C viru s infection.