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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
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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
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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.


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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).

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