Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening

Background and Methods There are few data on the prevalence and clinical ou tcome of hepatitis C infection in children. We studied 458 children who und erwent cardiac surgery in Munich, Germany, before 1991, when blood-donor sc reening for hepatitis C was introduced in Germany. Their mean age at first operation was 2.8 years; none of the children had received blood transfusio ns before or after cardiac surgery, and none of their mothers had antibodie s to hepatitis C virus (anti-HCV). We compared these patients with 458 cont rol subjects matched for age and sex. Results Sixty-seven (14.6 percent) of the 458 patients who had undergone cardiac surgery had anti-HCV, as compar ed with 3 (0.7 percent) of the control subjects (P<0.001). At a mean interv al of 19.8 years after the first operation, 37 (55 percent) of the 67 patie nts who were positive for anti-HCV had detectable HCV RNA in their blood. T he infection had cleared in the other 30 patients, as evidenced by negative results on three polymerase-chain-reaction analyses performed at six-month intervals. Only 1 of the 37 patients who were positive for HCV RNA had ele vated levels of liver enzymes; that patient had severe right-sided congesti ve heart failure. Of the 17 patients who underwent liver biopsies, only 3 h ad histologic signs of progressive liver damage. These three patients had a dditional risk factors: two had congestive heart failure, and the third had also been infected with hepatitis B virus. Conclusions Children who had un dergone cardiac surgery in Germany before the implementation of blood-donor screening for hepatitis C had a substantial risk of acquiring the infectio n. However, after about 20 years, the virus had spontaneously cleared in ma ny patients. The clinical course in those still infected seems more benign than would be expected in people infected as adults. (N Engl J Med 1999;341 :866-70.) (C) 1999, Massachusetts Medical Society.