DETECTION OF HEPATITIS-C VIRUS WITH RNA-POLYMERASE CHAIN-REACTION IN FULMINANT HEPATIC-FAILURE

The role of hepatitis C virus (HCV) infection in fulminant hepatic fai lure is controversial. The frequency of serum HCV RNA positivity in pr eviously reported patients with fulminant hepatic failure (FHF) of ind eterminate cause ranged from 0 to 12% in the United States and Europe and from 43% to 59% in Asia. We assessed serum HCV RNA using polymeras e chain reaction (PCR) and oligoprimers from the 5'UTR of the HCV geno me in 26 consecutive patients with FHF. Another laboratory independent ly performed PCR on 21 of the serum samples using different oligoprime rs from the 5'UTR and NS3 region of the HCV genome. Serum HCV RNA was detected in two of seven (28%) patients with hepatitis B, 9 of 15 (60% ) with an indeterminate cause, and in none with hepatitis A (n = 2) or drug-induced hepatotoxicity (n = 2). HCV RNA PCR results were concord ant between both laboratories in 17 of 21 (81%) of samples. In patient s with an indeterminate cause, HCV RNA positivity was significantly as sociated with the transmission risk factor of low socioeconomic status and Hispanic ethnicity. Eighteen patients underwent Liver transplanta tion (LT) and 15 (83%) survived. Among patients with EHF of indetermin ate cause, recurrent or acquired HCV infection after transplantation o ccurred in three of five (60%) and one of four (25%) patients, respect ively. Three of four (75%) patients with hepatitis C virus infection p ost-UT also developed histologic hepatitis. HCV appears to be the caus ative agent of a substantial number of cases of FHF classified as inde terminate in the Los Angeles area. Differences in patient populations or risk factors may explain the discordant incidences of HCV infection in FHF observed among different programs.