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Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up.

Publication ,  Journal Article
Strasser, SI; Myerson, D; Spurgeon, CL; Sullivan, KM; Storer, B; Schoch, HG; Kim, S; Flowers, ME; McDonald, GB
Published in: Hepatology
June 1999

Before the introduction of routine blood donor screening in 1991, marrow transplant recipients were at significant transfusion-associated risk for infection with hepatitis C virus (HCV). We followed a cohort of 355 patients undergoing transplant in Seattle during 1987 to 1988 to determine (1) the impact of pretransplant HCV infection on the occurrence and severity of venocclusive disease (VOD); (2) the impact of HCV infection on liver dysfunction, other than VOD, occurring between 21 and 60 days after transplantation; and (3) the natural history of post-transplant HCV liver disease with a 10-year follow-up. HCV-RNA status was determined on serum stored before transplant and at day 100 post-transplant. Sixty-two (17%) patients were HCV-RNA positive before transplant, and 113 (32%) were HCV-RNA positive by day 100 post-transplant (or before death). Severe VOD developed in 22 of 46 (48%) evaluable patients with pretransplant HCV infection and in 150 of 229 (14%) evaluable patients without HCV (P <.0001). In multivariable analysis of risk factors for developing VOD, pretransplant HCV infection associated with elevated serum aspartate transaminase (AST) levels predicted the development of severe VOD (relative risk, 9.6; P =.0001). The presence of HCV with normal AST levels before transplant was not a risk factor for severe VOD. Between 21 and 60 days after transplant, HCV-RNA positive-patients had higher AST levels (median 101 U/L), but similar alkaline phosphatase and total bilirubin levels compared with HCV-negative patients, suggesting that cholestatic liver disease (particularly graft-versus-host disease [GVHD]) was not related to HCV infection. An acute flare of hepatitis (AST >10 times the upper limit of normal) developed at a mean of 136 +/- 58 days in 31% of HCV-positive patients; no patients developed fulminant hepatitis. Between 5 and 10 years after transplant, 57% of HCV-positive and 6% of HCV-negative patients had mild to moderate elevations of AST (P <. 0001), but HCV infection was not associated with excess mortality between 3 and 10 years after bone marrow transplantation. In summary, HCV infection with elevated AST levels is a significant risk factor for severe VOD after marrow transplant. However, the decision to proceed to transplantation in HCV-positive patients must balance the absolute risk of death from VOD against the risks of the underlying disease. In long-term survivors, HCV infection is not associated with excess mortality over 10 years of follow-up.

Duke Scholars

Published In

Hepatology

DOI

ISSN

0270-9139

Publication Date

June 1999

Volume

29

Issue

6

Start / End Page

1893 / 1899

Location

United States

Related Subject Headings

  • Time Factors
  • RNA, Viral
  • Postoperative Complications
  • Male
  • Liver Function Tests
  • Incidence
  • Humans
  • Hepatitis C
  • Gastroenterology & Hepatology
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Strasser, S. I., Myerson, D., Spurgeon, C. L., Sullivan, K. M., Storer, B., Schoch, H. G., … McDonald, G. B. (1999). Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up. Hepatology, 29(6), 1893–1899. https://doi.org/10.1002/hep.510290609
Strasser, S. I., D. Myerson, C. L. Spurgeon, K. M. Sullivan, B. Storer, H. G. Schoch, S. Kim, M. E. Flowers, and G. B. McDonald. “Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up.Hepatology 29, no. 6 (June 1999): 1893–99. https://doi.org/10.1002/hep.510290609.
Strasser SI, Myerson D, Spurgeon CL, Sullivan KM, Storer B, Schoch HG, et al. Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up. Hepatology. 1999 Jun;29(6):1893–9.
Strasser, S. I., et al. “Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up.Hepatology, vol. 29, no. 6, June 1999, pp. 1893–99. Pubmed, doi:10.1002/hep.510290609.
Strasser SI, Myerson D, Spurgeon CL, Sullivan KM, Storer B, Schoch HG, Kim S, Flowers ME, McDonald GB. Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up. Hepatology. 1999 Jun;29(6):1893–1899.
Journal cover image

Published In

Hepatology

DOI

ISSN

0270-9139

Publication Date

June 1999

Volume

29

Issue

6

Start / End Page

1893 / 1899

Location

United States

Related Subject Headings

  • Time Factors
  • RNA, Viral
  • Postoperative Complications
  • Male
  • Liver Function Tests
  • Incidence
  • Humans
  • Hepatitis C
  • Gastroenterology & Hepatology
  • Follow-Up Studies