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Long-term clinical and histopathological follow-up of chronic posttransfusion hepatitis
A M Di Bisceglie1, Z D Goodman, K G Ishak
1Liver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892.
Insights
Hepatitis C virus (HCV) caused most chronic non A, non B hepatitis after blood transfusions in heart surgery patients. About 20% developed cirrhosis, but many showed minimal symptoms despite liver damage.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Posttransfusion hepatitis is a concern, particularly non A, non B hepatitis.
- Heart surgery patients receiving transfusions are at risk for developing chronic liver disease.
Purpose of the Study:
- To evaluate the clinical and histopathological outcomes of chronic non A, non B hepatitis following blood transfusions in heart surgery patients.
- To determine the role of hepatitis C virus (HCV) in posttransfusion hepatitis and its long-term sequelae.
Main Methods:
- Evaluation of 1,070 patients undergoing heart surgery, identifying those with posttransfusion hepatitis.
- Clinical follow-up and liver biopsy for 39 patients with chronic non A, non B hepatitis.
- Detection of antibody to hepatitis C virus (anti-HCV) in patient serum.
Main Results:
- Hepatitis C virus antibody was detected in 82% of patients with posttransfusion non A, non B hepatitis.
- Cirrhosis developed in 20% of patients within 1.5 to 16 years post-transfusion.
- Despite histological evidence of liver disease (chronic active hepatitis or cirrhosis) in 61% of patients, most remained asymptomatic.
Conclusions:
- Hepatitis C virus is the primary cause of chronic non A, non B posttransfusion hepatitis in this cohort.
- Chronic hepatitis C infection can lead to cirrhosis in approximately 20% of cases and end-stage liver disease in 12%.
- Many patients with significant liver pathology may exhibit minimal clinical symptoms during the study's follow-up period.
Abstract:
We have evaluated the clinical and histopathological outcomes of patients who contracted chronic non A, non B hepatitis as a result of transfusions administered during heart surgery at the National Institutes of Health. Posttransfusion hepatitis developed in 65 of 1,070 (6.1%) patients and became chronic in 45 (69%) of those cases. Antibody to hepatitis C virus was detectable in 53 patients (82%) with posttransfusion non A, non B hepatitis. Thirty-three patients with chronic non A, non B hepatitis agreed to liver biopsy (group 1). In addition, six other patients with chronic posttransfusion non A, non B hepatitis were evaluated (group 2). These 39 patients were followed between 1 and 24 yr (mean = 9.7 yr). Cirrhosis developed in 8 patients (20%) between 1.5 and 16 yr after blood transfusion. Of the 33 patients in group 1, 11 (33%) died during follow-up. In two cases (6%), this was related to liver failure. At this writing, two additional patients (6%) have decompensated cirrhosis and one (3%) had debilitating fatigue. Twenty of 33 patients (61%) with histological evidence of chronic active hepatitis or cirrhosis are asymptomatic and have no clinical evidence of liver disease. Thus chronic non A, non B posttransfusion hepatitis appeared to be due to hepatitis C virus infection in most cases. It was associated with the development of cirrhosis in approximately 20% of cases and end-stage liver disease in 12% of patients followed prospectively. Most patients with histological evidence of cirrhosis or chronic active hepatitis, however, had minimal clinical evidence of liver disease within the time frame of this study.