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Blood, 1 March 2004, Vol. 103, No. 5, pp. 1618-1624.
Prepublished online as a Blood First Edition Paper on October 23, 2003; DOI 10.1182/blood-2003-06-2145.
Submitted July 1, 2003
Accepted October 15, 2003
Long-term outcome of hepatitis C infection after bone marrow transplantation
Regis Peffault de Latour, Vincent Levy, Tarik Asselah, Patrick Marcellin, Catherine Scieux, Lionel Ades, Richard Traineau, Agnes Devergie, Patricia Ribaud, Helene Esperou, Eliane Gluckman, Dominique Valla, and Gerard Socie*
Hematologie-Greffe de Moelle, Hospital St Louis, Paris, France; INSERM ERM 0220, Hospital St Louis, Paris, France
INSERM ERM 321, Hospital St Louis, Paris, France
Service d'Hepatologie, Hospital Beaujon, Paris, France
Service de Virologie, Hospital St Louis, Paris, France
Service d'Hemobiologie, Hospital St Louis, Paris, France
* Corresponding author; email: gsocie{at}chu-stlouis.fr.
Chronic hepatitis C is often asymptomatic at least during the first decade following hematopoietic stem cell transplantation. Progression to advanced liver disease or cirrhosis in patients surviving more than ten years is currently thought to be a rare event. Among 1078 patients who underwent an allogeneic transplantation between January 1973 and January 1995, 686 were alive as of September 1st 1991 and were evaluated for HCV infection. Ninety-six patients infected by HCV during the transplant period were studied. Cumulative incidence and analysis of risk factors for cirrhosis were analyzed and the rate and risk of cirrhosis in transplant recipients was compared to those of 158 HCV-infected non-transplanted controls. At a median follow up of 15.7 years, 15 patients developed biopsy-proven cirrhosis leading to a cumulative incidence of cirrhosis of 11% and 24% at 15 and 20 years, respectively. By multivariate analysis, extra-hepatic HCV manifestations and HCV-genotype 3 were associated with risk of cirrhosis. The median time to cirrhosis in transplant recipients was 18 years as compared to 40 years in the control population. The risk of cirrhosis in transplant recipients relative to controls was highly significantly higher by multivariate analysis (p=0.0008). Roughly a quarter of long-term HCV-infected transplanted survivors progressed to cirrhosis that is much more rapid than in non-transplanted patients. Systematic detection of HCV infection in long-term marrow transplant recipients, liver biopsy and therapeutic intervention are thus warranted.
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