0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Incidence of Hepatitis C in Patients Receiving Different Preparations of Hepatitis B Immunoglobulins after Liver Transplantation

Cyrille Feray, MD, PhD; Michele Gigou, MD; Didier Samuel, MD, PhD; Beatrice Ducot, MD; Pascale Maisonneuve, MD; Michel Reynes, MD; Alain Bismuth, MD; and Henri Bismuth, MD
[+] Article and Author Information

From Centre Hepato-Biliare, Laboratoire d'Anatomo-Pathologie et Transfusion Sanguine, Hopital Paul Brousse, and Universite Paris-Sud, Villcjuif, France; Centre de Transfusion Sanguine, Le Chesnay, France; and CHU Bicetre, le Kremlin-Bicetre, France. Acknowledgments: The authors thank David Young for editorial support and Produits Roche for providing the Amplicor assays. Grant Support: By the Direction de la Recherche Clinique Assistance Publique-Hopitaux de Paris (CRC 950175), Association pour la Recherche sur le Cancer (RO 2038), and Institut National de la Sante et de la Recherche Medicale (CRI 9804). Requests for Reprints: Cyrille Feray, MD, Hopital Paul Brousse, 14 avenue Paul Vaillant-Couturier, 94800 Villejuif, France. Current Author Addresses: Drs. Feray, Gigou, Samuel, Reynes, A. Bismuth, and H. Bismuth: Hopital Paul Brousse, 14 avenue Paul Vaillant-Couturier, 94800 Villejuif, France.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(10):810-816. doi:10.7326/0003-4819-128-10-199805150-00003
Text Size: A A A

Background: Recurrence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection after liver transplantation is a clinical problem. Polyclonal immunoglobulins against hepatitis B surface antigen (HBIGs) prevent the recurrence of HBV infection, but no effective prophylaxis is available for HCV infection. Before screening of blood donors was introduced in France, HBIGs may have contained antibody to HCV (anti-HCV).

Objective: To determine the influence of HBIG on the occurrence of hepatitis C after liver transplantation before and after 1990.

Design: Retrospective cohort study.

Setting: Liver transplantation unit of a university hospital.

Patients: 428 consecutive patients who had liver transplantation because of cirrhosis between 1984 and 1994.

Measurements: Detection of serum HCV RNA before and 1 year after transplantation and findings on liver graft biopsy.

Results: Among the 218 patients who had HCV infection before transplantation, the incidence of HCV viremia after transplantation was lower in those receiving HBIG than in those not receiving HBIG (25 of 46 patients [54%] compared with 162 of 172 patients [94%]; P < 0.001). In patients receiving HBIG, the incidence of HCV viremia after transplantation was lower among those who had transplantation before March 1990 than among those who had transplantation after this date (15 of 33 patients [45%] compared with 10 of 13 patients [77%]; P = 0.05). Among the 210 patients without HCV infection before transplantation, acquired infection was significantly less frequent in those receiving HBIG than in those not receiving HBIG (18 of 68 patients [26%] compared with 40 of 86 patients [47%]; P < 0.001). Passively transmitted anti-HCV was transiently detected in patients receiving HBIG before March 1990. Multivariate analysis in patients with HCV infection before transplantation showed that the absence of HBIG and transplantation after March 1990 were independent significant risk factors for chronic hepatitis C after transplantation.

Conclusions: Polyclonal immunoglobulins that are treated for viral decontamination and contain anti-HCV could prevent HCV infection.

Figures

Grahic Jump Location
Figure 1.
Actual rates of hepatitis C virus (HCV)-related cirrhosis after transplantation.Top.PPBottom.PP

Data were analyzed by using the Kaplan-Meier method and the log-rank test. Hepatitis related to HCV infection was defined by the association of positivity for serum HCV RNA and of histologically defined lobular or chronic hepatitis. Numbers of patients available in each group are indicated at the top of each section. According to the post-transplantation administration of hepatitis B immunoglobulin (HBIG) to patients infected by HCV before transplantation (top left, < 0.001) and to patients who had transplantation before March 1990 and did not have pretransplantation markers of HCV infection (top right, < 0.05). According to the date of transplantation in patients who were infected with HCV and HBV before transplantation and who received HBIG (bottom left, = 0.001) and in patients infected with HCV alone (bottom right, > 0.2).

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)