Incidence of hepatitis C in patients receiving different preparations of hepatitis B immunoglobulins after liver transplantation.

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.