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Prepublished online as a Blood First Edition Paper on April 17, 2002; DOI 10.1182/blood-2001-12-0192.
Submitted December 6, 2001
Accepted February 14, 2002
Age at infection affects the long-term outcome of transfusion-associated chronic hepatitis C
Eliseo Minola, Daniele Prati, Fredy Suter, Franco Maggiolo, Flavio Caprioli, Aurelio Sonzogni, Mirella Fraquelli, Silvia Paggi, and Dario Conte*
Ospedali Riuniti, Infectious Diseases Unit, Bergamo, Italy
IRCCS Ospedale Maggiore, Transfusion and Transplant Immunology Center, Milan, Italy
IRCCS Ospedale Maggiore, Postgraduate School of Gastroenterology, Milan, Italy
* Corresponding author; email: dario.conte{at}unimi.it.
Introduction: Before the introduction of hepatitis C virus screening for blood donors, the risk of
acquiring HCV infection as a result of a transfusion was about 10%. The aim of this study was to
assess the frequency and rate of progression to cirrhosis in patients with transfusion-associated
chronic HCV infection, and identify possibly negative prognostic factors.
Patients and methods: Of 2477 consecutive patients with clinical or laboratory evidence of liver
disease, 392 (16%) were anti-HCV and HCV-RNA positive, had anamnestic evidence of a single and precisely-dated transfusion event, and showed no other causes of chronic liver disease; 268 (68%) underwent US-guided liver biopsy and were enrolled in the study.
Results: After a mean interval of 18.4 years, 54 patients (20.1%) had cirrhosis, which multivariate
analysis showed to be independently associated with the duration of follow-up, age at infection and
at the time of liver biopsy, and serum ALT levels at biopsy. The time necessary to have a 50%
probability of developing cirrhosis in patients aged 21-30, 31-40 and >40 years was respectively 33,
23 and 16 years. In comparison with those aged  20 years at infection, the risk ratio of developing
cirrhosis over a period of 30 years for patients aged 21-30 and  31 years at infection was
respectively 4.51 (95% CI: 1.03-19.76) and 12.29 (95% CI: 3.06-49.40).
Conclusions: In patients with transfusion-associated chronic hepatitis C, the risk of cirrhosis is
related to age at infection and disease activity. Our findings suggest that an aggressive therapeutic
approach should be adopted in patients infected by HCV at an older age in order to prevent the
progression to end-stage liver disease.
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