Prevalence of Hepatitis C Viremia in Heart Transplant Recipients: A Single-Center Experience

Abstract

Background: The existence of occult hepatitis C virus (HCV) infection, irrespective of the presence of anti-HCV antibodies or elevated liver function tests, has been shown in several studies. Diagnosis of such occult, subclinical HCV infection may have prognostic relevance in the immunocompromised host. In this study, we estimated the prevalence of HCV-RNA positivity, even at trace levels, in a large cohort of heart transplant recipients (HTRs).

Methods: We studied a retrospective cohort of 134 HTRs, for 55 of whom we also studied samples from the organ donors, and a prospective cohort of 45 HTRs. As controls, we studied a cohort of seronegative blood donors (n = 126), and a group of patients with known HCV hepatitis. Sera were tested for HCV-RNA with a non-commercially available (i.e., a “homemade”), high-sensitivity-nested-reverse transcriptase polymerase chain reaction (hs-n-rt-PCR), HCV antigen, HCV antibodies, and markers of liver damage. Where HCV-RNA was positive, genotyping was performed and random samples were sequenced to confirm specificity of the test.

Results: HCV-RNA was positive in 5.5% of blood donors, 100% of hepatitis C patients, 21% of HTRs before transplant and 24% of HTRs after transplant. There was no evidence of a consistent transmission from donors to HTRs. A small proportion of HCV-RNA-positive HTRs were also positive for HCV antigen (< 10%) or for HCV antibodies (< 10%). HTRs with positive HCV-RNA showed a significantly higher level of liver damage markers.

Conclusions: In HTRs, there is a very high prevalence of positive, low level HCV viremia. This might be a consequence of health-care exposures and post-transplant immune suppression. The clinical consequences of this virologic phenomenon need to be further investigated.

Clin Infect Immun. 2021;6(3):75-81
doi: https://doi.org/10.14740/cii140