HEPATITIS-C VIRUS-INFECTION AND ALLOGENEIC BONE-MARROW TRANSPLANTATION

Serum antibodies to hepatitis C virus (HCV) were tested for inpatients undergoing allogeneic BMT to determine the risk of acquiring HCV infe ction and the role of HCV in posttransplant liver complications. The H CV seroconversion rate was evaluated according to the date of BMT and blood donor screening at the time. Anti-HCV antibodies (anti-HCV) were detected with a second-generation ELISA and confirmed with a second-g eneration radioimmunoblot assay. All patients received leukocyte-deple ted blood products and most received apheresis platelet concentrates. One hundred twenty of 181 consecutive patients transplanted from Janua ry 1987 to December 1998 were anti-HCV-negative before BMT, had at lea st 6 months of followup, and were thus evaluated for the seroconversio n rate. Before screening for non-A, non-B hepatitis, 14% of the patien ts seroconverted to HCV (0.44% per unit transfused). After introductio n of screening for alanine aminotransferase and antibodies to hepatiti s B core antigen the risk of seroconversion was 4% per patient (0.26% per unit). When, in addition, blood was screened for anti-HCV the risk fell to 1.6% (0.03% per unit). Positive anti-HCV status before and af ter BMT was not predictive of veno-occlusive disease, liver graft-vers us-host disease (GVHD), or death due to liver dysfunction. In contrast , the risk of chronic hepatitis was significantly increased.