Long-Term Follow-Up

What transplant survivors need to know about Hepatitis C


Q. Why is Hepatitis C a problem for some transplant survivors?

The Hepatitis C virus is spread primarily through exposure to blood from an infected person. Before the early 1990's, there was no blood test to determine if a blood or marrow donor was carrying the Hepatitis C virus. Routine testing of blood donors could not be performed until July 1992. Because this disease frequently has no symptoms for many years, donors were not aware that they had the disease. Often, transplant patients received many blood or platelet transfusions before and during the transplant process from a large number of donors. This exposure increased the chance of contracting Hepatitis C. In addition, transplant patients with Hepatitis C appear to have a much higher risk of serious liver damage. This higher risk may be due to the immunosuppression required during and after the transplant process. This immunosuppression could allow the virus to reproduce quickly and damage the liver at a much faster rate than in someone who is not immunosuppressed.

Long-term outcome of Hepatitis C infection after bone marrow transplantation
A silent epidemic in suvivors of hematopoietic cell transplantation


Q. If I received blood products or a transplant after July 1992, do I need to worry about having Hepatitis C?

The chance of contracting Hepatitis C from blood products after routine testing for the virus began is very small (1 in 100,000). Donors are screened both for the presence of the virus and any recent activities that are known risk factors for infection, such as IV drug use. However, Hepatitis C could still be contracted from other blood contact with an infected person, such as an accidental needle stick or sharing anything contaminated with blood, such as shaving razors. Although much less likely, Hepatitis C may also be contracted through sexual contact with an infected person.

Hepatitis C F.A.Q. at HepC.net

Q. What happens to the liver when someone has Hepatitis C?

Most people have no symptoms at the beginning of the infection. In 70 percent to 85 percent of people, the virus persists after the initial infection. This type of infection is called Chronic Hepatitis C. Many people with Chronic Hepatitis C have no symptoms. However, over a period of many years, the virus may cause liver damage. In some cases, the damage may be mild, while in other cases, the damage may be severe before the patient shows symptoms. If a person has tested positive for Hepatitis C, their doctor should perform regular tests to determine whether liver damage is occurring

In the general population, up to 70 percent of people with Chronic Hepatitis C may develop liver disease. The most common type of liver damage caused by Hepatitis C is scarring, which may eventually lead to cirrhosis (extensive scarring and interruption of blood flow through the liver). Studies have shown that, in general, about one in five people will develop cirrhosis after 20 years with Chronic Hepatitis C. About one in 50 people who develop cirrhosis will develop a type of liver cancer called hepatocellular carcinoma. The risks of cirrhosis and liver cancer may be higher in transplant patients due to periods of immunosuppression, which may allow the virus to reproduce and cause damage more quickly.

Hepatitis C F.A.Q. at HepC.net
Long-term outcome of Hepatitis C infection after bone marrow transplantation


Q. Is Hepatitis C treatable?

The standard treatment for Hepatitis C is a combination of two drugs: pegylated interferon and ribavirin. Treatment is recommended to last between 24 and 48 weeks, depending on the specific strain of virus. Treatment may be stopped early if blood tests show it is not effective, or if the patient cannot tolerate the side-effects of treatment. These side effects include flu-like symptoms, low blood counts, and fatigue. Approximately 80 percent of patients will have some of these side effects. While 70 percent of patients will show improvement with combined therapy, cure rates are around 40 percent. Not everyone with Chronic Hepatitis C should have treatment. Patients with little or no liver damage may be advised to continue close monitoring until the time that treatment becomes necessary.

Hepatitis C F.A.Q. at HepC.net
Chronic Hepatitis C

Q. If I have Chronic Hepatitis C, what else can I do to avoid liver damage?

The most important thing you can do to protect yourself from further liver damage is to avoid all alcoholic beverages. Even moderate drinking in a person with Chronic Hepatitis C can cause serious liver damage and increase the risks of cirrhosis and liver cancer. Talk to your doctor before taking any over-the-counter medications, including vitamins and natural remedies. Common ingredients in over-the-counter medications, such as acetaminophen or Tylenol can be very toxic to the liver if taken in larger doses or with alcohol. Vitamins and minerals that might normally be considered "good for you", such as vitamin A and iron may also harm the liver in a person with Chronic Hepatitis C. Most herbal and natural remedies have not been tested in people with Chronic Hepatitis C; however, a number of herbal supplements are known to be toxic to the liver.

Eating a healthy diet and avoiding exposure to toxic chemicals may also help keep your liver healthy. See:
Caring for your Liver