Epidemiology and natural history of hepatitis C infections in liver transplant recipients

Hepatitis C infection is common in patients undergoing liver transplantation. Few studies have focused on the prevalence and epidemiology of hepatitis C infection among liver transplant recipients since the implementation of donor screening for antibodies against the hepatitis C virus (anti-HCV). Using reverse transcription-polymerase chain reaction (RT-PCR) and genomic sequencing methods, we sought to determine the prevalence, epidemiology, and natural history of hepatitis C infections among 44 consecutive liver transplant patients between January and December 1991. All patients and donors were screened for antibodies against HCV with a first-generation test. Laboratory tests and liver biopsies were routinely done 12 months after transplantation. Serum samples from all organ donors and transplant recipients were analyzed for the presence of HCV-RNA. From four of the six HCV-RNA-positive patients, pre- and post-transplant serum samples were available for sequence analysis. No donor had detectable HCV-RNA. Six of 44 (13.6%) patients had detectable HCV-RNA before and after liver transplantation. Recurrent infection was documented in all who were infected before transplantation and was confirmed by genotype analysis in the four patients who were analyzed. No acquired infections were identified. After transplantation, the HCV-RNA-positive recipients had higher mean alanine aminotransferase (207±85 U/l vs 37±7 U/l; p<0.0001) and were more likely to have chronic hepatitis (50% vs 6%; p<0.03) than the HCV-RNA-negative recipients. We conclude that hepatitis C infections are not uncommon in the setting of liver transplantation, recurrent infections are practically universal after transplantation, and when donors are screened for antibodies against HCV, acquired infections are rare. The histologic changes associated with hepatitis C infections in liver transplant recipients are variable but tend to be mild. Future studies must assess the long-term effects of hepatitis C in liver transplant recipients and establish the appropriate use of organs from donors with detectable antibodies against HCV.