Prevalence and outcome of hepatitis C infection among heart transplant recipients.
BACKGROUND
Hepatitis C virus infection is common in organ transplant recipients, and can be associated with significant morbidity and mortality. A unique feature of this infection among immunosuppressed patients is that it can progress without the development of hepatitis C virus antibodies.


METHODS
To define the prevalence of hepatitis C virus infection in patients undergoing heart transplantation and identify clinical syndromes associated with hepatitis C virus infection in heart transplant recipients, we collected sera from 59 consecutive heart transplant recipients and their donors. Samples were tested before and after transplantation for hepatitis C virus antibodies with the use of a second-generation recombinant immunoblot assay and for hepatitis C virus RNA by means of reverse transcriptase polymerase chain reaction.


RESULTS
Four of 59 patients (7%) had hepatitis C virus-RNA detected in posttransplantation serum samples; but only one of these was anti-hepatitis C virus antibody positive. Two of the four patients with hepatitis C virus RNA detected after transplantation received organs from donors who were positive for hepatitis C virus RNA/anti-hepatitis C virus. One of these two recipients tested positive for hepatitis C virus antibody and hepatitis C virus RNA before transplantation. The other two patients received organs from hepatitis C virus negative donors and possibly acquired infection after transplantation from blood or immunoglobulin preparations. One patient was anti-hepatitis C virus positive before transplantation but had no detectable hepatitis C virus RNA, and hepatitis C virus infection did not develop after transplantation. Progressive hepatitis C virus-induced cholestatic liver disease that led to hepatic failure and death after heart transplantation occurred in one of the four patients.


CONCLUSIONS
Hepatitis C virus infection may occur after heart transplantation in the absence of anti-hepatitis C virus antibodies, and a syndrome of severe cholestatic liver disease may complicate heart transplantation in the presence of hepatitis C virus infection.
Zein
N N
NN
Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minn, USA.
McGreger
C G
CG
Wendt
N K
NK
Schwab
K
K
Mitchell
P S
PS
Persing
D H
DH
Rakela
J
J
D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000209:etiology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D015151:Immunoblotting; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D014019:Tissue Donors
D018937:Hepatitis C Antibodies; D012367:RNA, Viral