PREVALENCE AND OUTCOME OF HCV INFECTION AFTER CARDIAC SURGERY IN CHILDHOOD BEFORE 1991

M. Vogt , TH. Lang*, Ch. Klingler, A. Zeller*. B.Langer+, G. Frösner⁺, H. Meisner, J. Mess

German Heart Center, University Children's Hospital*, Max v. Pettenkofer Institute+ Munich, Germany

OBJECTIVE: Hepatitis C (HCV) has been known as the main cause of posttransfusion hepatitis since 1989. Worldwide very few data exist on the prevalence of HCV infection in pediatric patients after cardiac surgery. We reevaluated a study population comprising 486 pts. (mean age 18 years) under medical attendance of the German Heart Center Munich, having undergone operation before the introduction of blood donor screening (1991). As controls 486 age and sex matched, anonymized blood samples of the regional population were used.

METHOD: Serum samples werde collected and examined for anti-HCV antibodies by means of enzyme immuno assay (Abbott EIA II) and westernblot (Mikrogen, Munich) and directly for HCV-RNA by RT-PCR. In addition RNA positive samples were genotyped (RFLP) and quantitated (HCV Amplicor Roche). In all seropositive pts. tests for liver enzymes were performed.

RESULTS: Of the 486 pts. examined 14.6 % (n=67) were anti HCV positive as compared to 0.7 % of the controls (p<0.001). In 55% (n=37) of them HCV-RNA could be detected. Genotype distribution was as follows: 1 a (acc. to Simmonds) 40 %, 1 b - 59 %, 3 a < 1 %. RNA concentration ranged between 250 000 and 1,200 000 genome equivalents/ml. All pts. were clinically stable with only slightly elevated liver enzymes (ALT, AST < 60 U/L) in the positive group.

SUMMARY: These results show a significantly higher HCV prevalence among the cardiac surgery pts. as compared to normal controls. However, after a mean interval of 19 years 45 % of the infected patients had cleared the virus from circulation. The clinical course in those still infected seems more benign than would be expected in people infected as adults. M. Vogt et al, Prevalence and clinical outcome of Hepatitis C infection in children, N Engl. J Med 1999;341:866-70