Zein N N, McGreger C G, Wendt N K, Schwab K, Mitchell P S, Persing D H, Rakela J
Division of Gastroenterology, Mayo Clinic and Foundation, Rochester, Minn, USA.
J Heart Lung Transplant. 1995 Sep-Oct;14(5):865-9.
Hepatitis C virus infection is common in organ transplant recipients, and can be associated with significant morbidity and mortality. A unique feature of this infection among immunosuppressed patients is that it can progress without the development of hepatitis C virus antibodies.
To define the prevalence of hepatitis C virus infection in patients undergoing heart transplantation and identify clinical syndromes associated with hepatitis C virus infection in heart transplant recipients, we collected sera from 59 consecutive heart transplant recipients and their donors. Samples were tested before and after transplantation for hepatitis C virus antibodies with the use of a second-generation recombinant immunoblot assay and for hepatitis C virus RNA by means of reverse transcriptase polymerase chain reaction.
Four of 59 patients (7%) had hepatitis C virus-RNA detected in posttransplantation serum samples; but only one of these was anti-hepatitis C virus antibody positive. Two of the four patients with hepatitis C virus RNA detected after transplantation received organs from donors who were positive for hepatitis C virus RNA/anti-hepatitis C virus. One of these two recipients tested positive for hepatitis C virus antibody and hepatitis C virus RNA before transplantation. The other two patients received organs from hepatitis C virus negative donors and possibly acquired infection after transplantation from blood or immunoglobulin preparations. One patient was anti-hepatitis C virus positive before transplantation but had no detectable hepatitis C virus RNA, and hepatitis C virus infection did not develop after transplantation. Progressive hepatitis C virus-induced cholestatic liver disease that led to hepatic failure and death after heart transplantation occurred in one of the four patients.
Hepatitis C virus infection may occur after heart transplantation in the absence of anti-hepatitis C virus antibodies, and a syndrome of severe cholestatic liver disease may complicate heart transplantation in the presence of hepatitis C virus infection.
丙型肝炎病毒感染在器官移植受者中很常见，并且可能与严重的发病率和死亡率相关。这种感染在免疫抑制患者中的一个独特特征是，它可以在不产生丙型肝炎病毒抗体的情况下进展。
为了确定心脏移植患者中丙型肝炎病毒感染的患病率，并识别与心脏移植受者丙型肝炎病毒感染相关的临床综合征，我们收集了59例连续心脏移植受者及其供者的血清。在移植前后，使用第二代重组免疫印迹法检测血清样本中的丙型肝炎病毒抗体，并通过逆转录聚合酶链反应检测丙型肝炎病毒RNA。
59例患者中有4例（7%）在移植后血清样本中检测到丙型肝炎病毒RNA；但其中只有1例抗丙型肝炎病毒抗体呈阳性。移植后检测到丙型肝炎病毒RNA的4例患者中有2例接受了来自丙型肝炎病毒RNA/抗丙型肝炎病毒阳性供者的器官。这两名受者中有1例在移植前丙型肝炎病毒抗体和丙型肝炎病毒RNA检测呈阳性。另外两名患者接受了来自丙型肝炎病毒阴性供者的器官，可能在移植后从血液或免疫球蛋白制剂中获得感染。1例患者在移植前抗丙型肝炎病毒呈阳性，但未检测到丙型肝炎病毒RNA，移植后也未发生丙型肝炎病毒感染。4例患者中有例发生了进行性丙型肝炎病毒诱导的胆汁淤积性肝病，导致心脏移植后肝衰竭和死亡。
在没有抗丙型肝炎病毒抗体的情况下，心脏移植后可能发生丙型肝炎病毒感染，并且在存在丙型肝炎病毒感染的情况下，严重胆汁淤积性肝病综合征可能使心脏移植复杂化。
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