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Hepatitis G virus in patients with cryptogenic liver disease undergoing liver transplantation
M G Pessoa1, N A Terrault, L D Ferrell
1Department of Medicine, Department of Veterans Affairs Medical Center and University of California, San Francisco 94121, USA.
Insights
Hepatitis G virus (HGV) RNA was common after liver transplants for unknown liver disease, but did not cause post-transplant hepatitis. Unidentified viruses may contribute to liver disease after transplantation.
Area of Science:
- Hepatology
- Virology
- Transplantation Immunology
Background:
- Cryptogenic cirrhosis is a common indication for liver transplantation.
- The role of Hepatitis G virus (HGV) in end-stage liver disease and post-transplant hepatitis remains unclear.
Purpose of the Study:
- To determine HGV prevalence in end-stage liver disease of unknown cause.
- To investigate the association between HGV infection and post-transplant hepatitis.
Main Methods:
- HGV RNA detection and quantification using PCR and branched DNA (bDNA) assay.
- Analysis of liver biopsies and clinical outcomes in 46 liver transplant recipients with cryptogenic cirrhosis.
- Comparison of post-transplant hepatitis prevalence between HGV-positive and HGV-negative patients.
Main Results:
- HGV RNA prevalence was 22% pre-transplant and 67% post-transplant.
- No significant difference in post-transplant hepatitis rates between HGV-positive (38%) and HGV-negative (22%) patients.
- Higher histological scores in HGV-infected patients, but overall low severity and no correlation with HGV RNA levels.
- Graft and patient survival were not significantly affected by HGV status.
Conclusions:
- HGV infection is common after liver transplantation for cryptogenic cirrhosis but does not appear to cause significant post-transplant hepatitis.
- Mild liver disease is frequent after transplantation in this cohort.
- The presence of post-transplant hepatitis in the absence of known viruses suggests the involvement of unidentified infectious agents.
Abstract:
To examine the prevalence of hepatitis G virus (HGV) in end-stage liver disease of unknown cause and the role of HGV infection in posttransplantation hepatitis, we studied 46 patients undergoing liver transplantation (mean age, 50 years; M:F, 18:28) with cryptogenic cirrhosis. HGV RNA was detected by polymerase chain reaction (PCR) and was quantified by a branched DNA (bDNA) assay. The prevalence of HGV RNA was determined in samples collected before and after liver transplantation and was found to be 22% and 67%, respectively. We evaluated the prevalence of posttransplantation hepatitis in 25 patients, 16 of whom were HGV-positive and 9 were HGV-negative. The proportion of patients with hepatitis was not significantly different in the two groups (38% in HGV-positive and 22% in HGV-negative patients). The median histological scores were significantly higher in liver biopsies from patients with HGV infection than in those without HGV infection (2 [range, 0-14] and 1 [range, 0-3]; P = .01), but the histological scores were low overall. The duration of follow-up was similar in the two groups. HGV RNA levels were not correlated with the severity of liver disease based on histological score (r = -.08). Graft survival and patient survival were not significantly different. We concluded that liver disease was frequent (32%) after transplantation in patients with a pretransplantation diagnosis of cryptogenic cirrhosis, although the disease was generally mild. Although HGV RNA was demonstrable in the majority (67%) of patients after transplantation, there was no relationship between the presence of HGV RNA and the presence of posttransplantation liver disease. The finding of posttransplantation hepatitis in the absence of known viruses (A-G), suggests that other, as-yet-unidentified viruses may be important.