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Hepatitis C in Patients Undergoing Liver Transplantation

Alexandra E. Read, MD; Elizabeth Donegan, MD; John Lake, MD; Linda Ferrell, MD; Cynthia Galbraith, RN; I. K. Kuramoto, BS; Jerome B. Zeldis, MD, PhD; Nancy L. Ascher, MD, PhD; John Roberts, MD; and Teresa L. Wright, BM, BS
[+] Article, Author, and Disclosure Information

Grant Support: In part by NIDDK grant DK-26743 and a grant from the Academic Senate University of California, San Francisco, California.

Requests for Reprints: Alexandra E. Read, MD, Gastroenterology Unit (1120 HSW) University of California, San Francisco, San Francisco, California 94143-0538.

Current Author Addresses: Drs. Read and Lake: Department of Medicine, University of California, San Francisco, CA 94143.

Dr. Donegan: Department of Laboratory Medicine, University of California, San Francisco, CA 94143

Dr. Ferrell: Department of Pathology, University of California, San Francisco, CA 94143.

Ms. Galbraith and Drs. Ascher and Roberts: Department of Surgery, University of California, San Francisco, CA 94143.

Mr. Kuramoto: Center for Blood Research, 1631 Stockton Boulevard, Sacramento, CA 95816.

Dr. Zeldis: Department of Medicine, University of California, Davis, Sacramento, CA 95816.

Dr. Wright: Department of Medicine, Veterans Affairs and University of California, San Francisco, CA 94143.

Ann Intern Med. 1991;114(4):282-284. doi:10.7326/0003-4819-114-4-282
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Objective: To determine the prevalence of antibodies to hepatitis C virus (anti-HCV) among patients undergoing liver transplantation and the relation between anti-HCV and post-transplant hepatitis.

Design: Retrospective cohort.

Patients: Serum samples from 128 patients who underwent liver transplantation. Sixty-six patients who had 6 months of follow-up and for whom both pretransplant and post-transplant serum samples were available were included in a study to assess the relation between anti-HCV and post-transplant hepatitis.

Measurements: Sera were tested for anti-HCV using an enzyme-linked immunosorbent assay (ELISA) and, if positive, two confirmatory tests were done. Patients had a biopsy every week until two specimens showed no abnormal findings.

Main Results: Only patients with chronic non-A non-B hepatitis (15 of 30; 50%), alcoholic cirrhosis (7 of 19; 37%), and chronic hepatitis B infection (3 of 11; 27%) were anti-HCV positive. No patient with another form of chronic liver disease or with acute liver failure due to non-A non-B hepatitis was anti-HCV positive. After transplantation, loss of anti-HCV was frequent and acquisition rare. Hepatitis developed in the graft in 17% of patients, but the incidence was similar among anti-HCV negative and anti-HCV-positive patients.

Conclusions: Hepatitis C virus is a common cause of chronic liver disease in patients requiring liver transplantation, but anti-HCV is rarely found in patients with acute liver failure. Previous HCV infection, based on detection of anti-HCV, is not an independent risk factor for post-transplant hepatitis.





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