Allograft transmission of hepatitis C virus infection from infected donors in cardiac transplantation.
BACKGROUND
The frequency and outcome of hepatitis C virus (HCV) infection in recipients of hearts from HCV-infected donors remains poorly characterized.


METHODS
Between 1991 and 1999, 10 anti-HCV-negative patients received hearts from donors who were anti-HCV and HCV RNA-positive. Each recipient was tested for anti-HCV and HCV RNA and serially evaluated for liver dysfunction. Recipient records were reviewed for cumulative steroid boluses in the first posttransplant year and other components of the immune suppression regimen. We analyzed recipient outcome in relation to the virologic status of the donor, including the level of HCV RNA and genotype and the type of antirejection therapy.


RESULTS
All 10 recipients became HCV RNA positive. Donor-recipient pairs expressed identical genotypes in each instance. Six of nine evaluable recipients developed biochemical evidence of hepatitis. Recipients with genotype 1 (1a, 1b) accounted for five of the six cases, and all patients with genotype 1 developed hepatitis. Severe liver injury occurred in two patients. Two deaths occurred, both of which were genotype 1 patients who had been given multiple boluses of corticosteroids in the first posttransplant year. No definite relationship between viral load in the donor and recipient outcome was found.


CONCLUSIONS
Transmission of HCV infection from cardiac donors who are viremic at the time of organ donation occurs with high frequency and can cause severe hepatitis. Hearts from infected patients should probably be restricted to those recipients who already have evidence for hepatitis C or are in need of emergent transplantation.
File
Elizabeth
E
Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.
Mehra
Mandeep
M
Nair
Satheesh
S
Dumas-Hicks
Debbie
D
Perrillo
Robert
R
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D004334:Drug Administration Schedule; D005260:Female; D005838:Genotype; D016027:Heart Transplantation; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000401:mortality / Q000473:pathology / Q000635:transmission* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012367:RNA, Viral / Q000032:analysis; D014019:Tissue Donors; D014184:Transplantation, Homologous
D000305:Adrenal Cortex Hormones; D012367:RNA, Viral