Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long‐term follow up (1989–January 1997)

Abstract

Almroth G, Ekermo B, Månsson A‐S, Svensson G, Widell A. (University Hospital of Linköping; University Hospital of Malmö, Sweden) Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long‐term follow up (1989–January 1997). J Intern Med 2002; 251: 119–128. Background. Hepatitis C is frequent problem in dialysis wards. Design. A long time (1989–97) follow up of hepatitis C virus (HCV) infection in a Swedish nephrology unit was performed with anti‐HCV screening, confirmatory antibody tests, viral RNA detection and molecular characterization. Case histories were reviewed with focus, onset of infection, liver morbidity and mortality. Results. In October 1991, 10% (19 of 184) of the patients in the unit (haemodialysis‐, peritoneal dialysis and transplanted patients) were verified or suspected HCV carriers, whilst the number at the end of 1996 was 8% (13 of 157). Most patients were infected before 1991 but only in one case from a known HCV‐infected blood donor. No new HCV infections associated with haemodialysis occurred during the study period. A total of 13 of 24 viremic patients had HCV genotype 2b, a pattern suggesting nosocomial transmission. This was further supported by phylogenetic analysis of HCV viral isolates in seven. HCV viremia was also common in patients with an incomplete anti‐HCV antibody pattern as 8 of the 12 indeterminant sera were HCV‐RNA positive. Conclusions. Awareness, prevention, identification of infected patients and donor testing limited transmission. Indeterminant recombinant immunoblot assays (RIBA)‐results should be regarded with caution as a result of the relative immunodeficiency in uremic patients. Our data indicate nosocomial transmission in several patients.