Cardiac Surgeon
Transmission of Hepatitis C Virus by a Cardiac Surgeon
Volume 334:555-561 February 29, 1996 Number 9
Juan I. Esteban, M.D., Jordi Gómez,
Ph.D., María Martell, Ph.D., Beatriz Cabot, Ph.D., Josep Quer,
Ph.D., Joan Camps, M.D., Antonio González, M.D., Teresa Otero, M.T.,
Andrés Moya, Ph.D., Rafael Esteban, M.D., and Jaime Guardia, M.D.
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.
Full Text of this Article
Related Letters:
Transmission of Hepatitis Viruses by Surgeons
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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