SEROLOGIC AND VIROLOGICAL PROFILES OF HEPATITIS-C INFECTION IN RENAL-TRANSPLANT CANDIDATES

The development of policies to prevent nosocomial transmission of hepa titis C virus (HCV) infection in hemodialysis units is critically depe ndent on the understanding of the relationship between rests for anti- HCV, HCV RNA, and HCV genotype and the patients' clinical characterist ics. We tested sera from all patients on the renal transplant waiting list at the New England Organ Bank between November 1986 and June 1990 for anti-HCV by a third-generation enzyme-linked immunosorbent assay (ELISA3) and a third-generation recombinant immunoblot assay (RIBA3). All ELISA3-positive sera were tested for HCV RNA by reverse transcript ase ''nested'' polymerase chain reaction, and the genotype was charact erized by restriction fragment length polymorphism. Sera were availabl e in 1,544 of 3,243 (48%) patients on the waiting list, of whom 287 (1 9%) tested positive for anti-HCV by ELISA3. Two hundred eighty-six ran domly selected, anti-HCV-negative patients served as controls. Compare d with anti-HCV-negative controls, anti-HCV-positive patients had a lo nger duration since initiation of renal replacement therapy, higher nu mber of previous kidney transplants and blood transfusions, higher pro portion of patients with anti-HBc, history of liver disease, history o f non-A, non-B hepatitis, and elevated serum alanine aminotransferase, and lower serum albumin concentrations. Of the 287 anti-HCV-positive sera, 261 (91%) were reactive by RIBA3, 21 (7%) were indeterminate, an d five (2%) were nonreactive. HCV RNA was detected in 224 of 275 (81%) ELISA3-positive patients, in whom additional sera were available. The re were no significant differences in clinical or laboratory character istics between ELISA3-positive patients with and without HCV RNA. Geno types la, 1b, 2a, 2b, 3a, and 4 were present in 53%, 23%, 8%, 10%, 4%, and 2% of patients, respectively. infection with one, two, or three d ifferent HCV genotypes was present in 92%, 7%, and 1%, respectively. T here was no significant association between the type or number of HCV genotypes and RIBA3 reactivity. There were no major differences in cli nical or laboratory characteristics between genotypes or between singl e and mixed infection. in summary, this study provides detailed inform ation regarding the relationship between tests for anti-HCV, HCV RNA, and HCV genotypes and the clinical and laboratory characteristics of a large, well-characterized cohort of patients referred for renal trans plant. (C) 1998 by the National Kidney Foundation, Inc.