Recurrent and new hepatitis C virus infection after liver transplantation.
Chronic infection with the hepatitis C virus (HCV) is the most common reason for liver transplantation. We examined the results of laboratory tests for 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 604 donors were tested for antibody to HCV (anti-HCV) using a second-generation enzyme-linked immunoassay (EIA-2), followed by recombinant immunoblot (RIBA-2) and HCV RNA confirmation by reverse-transcription polymerase chain reaction (RT-PCR) (with genotyping and viral quantification). Diagnosis of posttransplantation infection required detection of serum HCV RNA that could be genotyped by sequencing or was repeatedly positive despite being unsequenceable. Twenty-five percent of transplantation candidates were seropositive for anti-HCV. Approximately 86% of anti-HCV-positive, 93% of RIBA-positive, and 97% of HCV RNA-positive candidates developed infection after transplantation. Pretransplantation HCV RNA was superior to RIBA-2 for predicting posttransplantation infection. Whereas HCV genotype was identified in nearly all candidates and changed little after transplantation, serum viral levels rose markedly after transplantation. Fifteen donors were either anti-HCV- or HCV RNA-positive. Recipients of grafts from donors with HCV RNA all developed infection, whereas infection was not detected in recipients of grafts from donors with anti-HCV but without detectable HCV RNA. The rate of new infection fell significantly (P =.02) after the introduction of EIA-2 screening of blood. Donor and candidate markers for HCV predict posttransplantation infection.
Everhart
J E
JE
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA. vyj@cu.nih.gov
Wei
Y
Y
Eng
H
H
Charlton
M R
MR
Persing
D H
DH
Wiesner
R H
RH
Germer
J J
JJ
Lake
J R
JR
Zetterman
R K
RK
Hoofnagle
J H
JH
D015331:Cohort Studies; D005544:Forecasting; D005838:Genotype; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D015203:Reproducibility of Results; D012698:Serologic Tests; D014019:Tissue Donors; D014180:Transplantation; D019562:Viral Load
D018937:Hepatitis C Antibodies; D012367:RNA, Viral