HEPATITIS-C VIRUS-INFECTION DETECTED BY ANTIBODY TESTS AND THE POLYMERASE CHAIN-REACTION AS A CAUSE OF LIVER DYSFUNCTION IN RENAL-TRANSPLANT RECIPIENTS

Hepatitis C infection (HCV) is more prevalent in patients who have rec eived kidney transplants than in the general population but the morbid ity and mortality associated with infection in this group is unclear. Sera taken from 36 renal transplant recipients with chronic liver dysf unction and from 42 with normal liver function were tested for HCV inf ection by second generation ELISA (Abbott Laboratories) and second gen eration recombinant immunoblot assay (Chiron Corporation) (RIBA-2). Ev idence of HCV replication was sought by reverse transcription polymera se chain reaction (RT PCR) using primers from the 5' nontranslated reg ion (5'NTR). Infection was detected in 20/36 (54%) and in 2/42 (4.8%) controls (P < 0.01). Twelve liver dysfunction patients were positive b y all three tests, six were positive by ELISA and RT PCR but had indet erminate RIBA-2, one was positive by ELISA and RIBA but negative by RT PCR, and one was positive only by RT PCR. Of two infected control pat ients, one was positive by all three tests and one who was later found to have been in the early stage of infection was positive only by RT PCR. Follow-up of infected patients showed persistence of viraemia in 14/15 (93%). Evidence of infection with different types of HCV was sho wn by the lack of amplification by RT PCR by primers with mismatching bases with HCV types 2 and 3. It is concluded that in our renal transp lant patients, chronic HCV infection is usually associated with liver dysfunction and persistent infection is common, (C) 1994 Wiley-Liss, I nc.