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Previous Volume 334:555-561 February 29, 1996 Number 9 Next

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ABSTRACT

Background In the course of a study conducted from 1992 through 1994 of the efficacy of screening blood donors for antibodies to hepatitis C virus (HCV), we found that two patients had acquired hepatitis C after cardiac surgery, with the transmission apparently unrelated to blood transfusions. Because their surgeon had chronic hepatitis C, we sought to determine whether he was transmitting the virus to his patients.

Methods Of 222 of the surgeon's patients who participated in studies of post-transfusion hepatitis between 1988 and 1994, 6 contracted postoperative hepatitis C, despite the use of only seronegative blood for transfusions. All six patients had undergone valve-replacement surgery. Analyses were performed to compare nucleotide sequences encompassing the hypervariable region at the junction between the coding regions for envelope glycoproteins E1 and E2 in the surgeon, the patients, and 10 controls infected with the same HCV genotype.

Results The surgeon and five of the six patients with hepatitis C unrelated to transfusion were infected with HCV genotype 3; the sixth patient had genotype 1 and was considered to have been infected from another source. Thirteen other patients of the surgeon had transfusion-associated hepatitis C and were also infected with genotype 1. The average net genetic distance between the sequences from the five patients with HCV genotype 3 and those from the surgeon was 2.1 percent (range, 1.1 to 2.5 percent; P<0.001), as compared with an average distance of 7.6 percent (range, 6.1 to 8.3 percent) between the sequences from the patients and those from the controls. The results of a phylogenetic-tree analysis indicated a common epidemiologic origin of the viruses from the surgeon and the five patients.

Conclusions Our findings provide evidence that a cardiac surgeon with chronic hepatitis C may have transmitted HCV to five of his patients during open-heart surgery.

Source Information

From the Liver Unit, Department of Medicine, Hospital General Universitari Vall d'Hebron, Universitat Autònoma, Barcelona (J.I.E., J. Gomez, M.M., B.C., J.Q., J.C., A.G., T.O., R.E., J. Guardia) and the Department of Genetics, Universitat de Valencia, Valencia (A.M.) — both in Spain.

Address reprint requests to Dr. Juan Esteban at Servei de M. Interna-Hepatología, Hospital General Universitari Vall d'Hebron, P° Vall d'Hebron 119, 08035 Barcelona, Spain.

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Goodman D. B.P., Deysine M., Wittig G., Jorde U. P., Kressel A. B., Potasman I., Pick N., Harpaz R., Shapiro C. N., Cherry J. D., Esteban J. I., Esteban R., Guardia J., Gerberding J. L.
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N Engl J Med 1996; 335:284-287, Jul 25, 1996. Correspondence

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