Recurrent and new hepatitis C virus infection after liver transplantation

Chronic infection with the hepatitis C virus (HCV) is the most common reaso n for liver transplantation. We examined the results of laboratory tests fo r HCV on a cohort of patients who received a liver transplant between 1990 and 1994 at three large centers, Seven hundred twenty-two recipients and 60 4 donors were tested for antibody to HCV (anti-HCV) using a second-generati on enzyme-linked immunoassay (EIA-2), followed by recombinant immunoblot (R IBA-2) and HCV RNA confirmation by reverse-transcription polymerase chain r eaction (RT-PCR) (with genotyping and viral quantification). Diagnosis of p osttransplantation infection required detection of serum HCV RNA that could be genotyped by sequencing or was repeatedly positive despite being unsequ enceable, Twenty-five percent of transplantation candidates were seropositi ve for anti-HCV, Approximately 86% of anti-HCV-positive, 93% of RIBA-positi ve, and 97% of HCV RNA-positive candidates developed infection after transp lantation. Pretransplantation HCV RNA was superior to RIBA-2 for predicting posttransplantation infection. Whereas HCV genotype was identified in near ly all candidates and changed little after transplantation, serum viral lev els rose markedly after transplantation. Fifteen donors were either anti-HC V- or HCV RNA-positive. Recipients of grafts from donors with HCV RNA all d eveloped infection, whereas infection was not detected in recipients of gra fts from donors with anti-HCV but without detectable HCV RNA. The rate of n ew infection fell significantly (P = .02) after the introduction of EIA-2 s creening of blood. Donor and candidate markers for HCV predict posttranspla ntation infection.