The aim of this study was to investigate long-term clinical, virologic and histologic outcome of hepatitis C virus infection in children. Sixty children (16 girls and 44 boys) have been followed for 1 to 5 years (mean 1.7 +/- 0.9 years). HCV RNA and anti-HCV were checked every six months. Biopsy specimens were evaluated for the grade of inflammation and stage of fibrosis (scores 0-4). ALT was measured every 3 months. Presumed duration of HCV infection was from 1 to 16 years (mean 7.4 +/- 3 years). Fifteen (25%) children could have been infected by blood transfusion, 5 (8%) during surgical procedures, 29 (50%) were multiply hospitalized. Twenty-five children infected as neonates had lower staging score than 24 infected later in life (p = 0.021). Two girls (aged 13 and 14) were diagnosed with acute hepatitis C, with maximum ALT of 1272 U/l and 1638 U/l respectively. In 11 children (18%) median ALT of more than 3 times the normal value (> 105 U/l) was noted. Six children (10%) had continuously normal ALT. Histopathology revealed mild to moderate inflammatory activity (0-2 points) in 52 children (87%). Seven specimens (11%) were scored for 3 to 4 staging points, 3 of them (5%) were diagnosed with liver cirrhosis. We have found statistically significant correlation between median ALT and grading (r = 0.36; p = 0.005) as well as staging scores (r = 0.32; p = 0.016), median AST and grading (r = 0.36; p = 0.006) as well as staging (r = 0.36; p = 0.007) scores but also median GGT and staging score (r = 0.39; p = 0.004).