title: Outcomes of a hepatitis C screening protocol in at-risk adults with prior cardiac surgery.
abstract: BACKGROUND
  Symptoms associated with hepatitis C infection often do not develop until an advanced stage of liver disease. Prior to 1992, reliable testing for hepatitis C was unavailable, resulting in potential patient exposure during cardiopulmonary bypass. As the hepatitis C prevalence in our center was unknown, a screening protocol for patients who underwent surgery prior to 1992 was developed.
  
  
  METHODS
  Patients evaluated in the Wisconsin Adult Congenital Heart Disease program who underwent surgery prior to 1992 were screened for hepatitis C as part of their initial clinical evaluation. The hepatitis C-positive patients were assessed for risk factors, level of hepatic involvement, whether they received treatment, and whether viral clearance was obtained.
  
  
  RESULTS
  A total of 147 patients (53% male) underwent testing. Seven (4.8%) patients had evidence of chronic hepatitis C infection, which is higher than the Wisconsin reported prevalence of 0.3%. Six of the seven patients had elevated liver enzymes at time of diagnosis. No relationship was found between hepatitis C infection and number of surgeries, year of surgery, or age at surgery. Four patients had hepatitis C genotype 1, but none achieved viral clearance despite three having received treatment. Three had genotype 2, were treated, and had viral clearance. No hepatitis C-positive patient developed cirrhosis or required liver transplant.
  
  
  CONCLUSIONS
  Hepatitis C infection in patients with congenital heart disease who underwent surgical palliation prior to 1992 is common, with prevalence higher than the general population. Our data emphasize the continued importance of screening the high-risk adult congenital heart disease patients.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA dcox@chw.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Cox
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Salil
authors.initials: S
authors.lastname: Ginde
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA Division of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Earing
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002985:Clinical Protocols; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006526:Hepatitis C / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult
keywords: adult congenital heart disease; blood transfusion; infection; pathology (hepatic)