A CONTROLLED-STUDY OF HEPATITIS-C TRANSMISSION BY ORGAN-TRANSPLANTATION

Hepatitis C virus (HCV) can be transmitted by transplantation of cadaver organs from donors with antibody to HCV (anti-HCV); therefore, transplantation of organs from anti-HCV positive donors to anti-HCV-negative recipients has been discouraged. We have looked at outcomes in recipients of organs from anti-HCV positive and negative donors to determine whether this advice is well-founded. Stored sera from 716 consecutive cadaver organ donors procured by the New England Organ Bank between 1986 and 1990 were tested for anti-HCV by a first-generation ELISA (ELISA1); 13 (1.8%) were positive. 29 recipients who received organs from these donors were the study group. 37 donors were randomly selected from 703 ELISA1-negative cadaver organ donors. 74 recipients of organs from these 37 donors were the control group. Clinical records were reviewed and recipient sera were tested for anti-HCV with a second-generation ELISA (ELISA2), and HCV RNA was tested for by polymerase chain reaction. Median post-transplant follow-up was 42 and 49 months for study and control groups. Post-transplantation prevalence of anti-HCV and HCV RNA was 67% and 96% among recipients from anti-HCV-positive donors, and 20% and 18% among recipients from anti-HCV-negative donors (p<0.001). Post-transplantation non-A, non-B hepatitis, graft loss, and death were observed in 55%, 52%, and 31% among recipients of organs from anti-HCV-positive donors, and 16%, 53%, and 33% among recipients from anti-HCV-negative donors. In a proportional hazards model, the relative risks for non-A, non-B hepatitis, graft loss, and death among recipients from anti-HCV-positive donors were 4.37 (95% Cl 1.97-9.70), 0.93 (0.51-1.70), and 0.89 (0.41-1.93). Transmission of HCV infection by organ transplantation increased the risk of liver disease among recipients. However, after 3.5 years, donor HCV infection did not adversely affect patient survival or graft survival.