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Hepatitis G virus infection in patients transplanted for cryptogenic cirrhosis: red flag or red herring?
M R Charlton1, D Brandhagen, R H Wiesner
1Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Insights
Hepatitis G virus (HGV) infection is prevalent in liver transplant recipients, with viral loads increasing post-transplant. Persistent HGV infection is linked to unexplained hepatitis in these patients.
Area of Science:
- Hepatology
- Virology
- Transplantation Immunology
Background:
- The role of Hepatitis G Virus (HGV) infection in liver transplant recipients remains unclear.
- This study investigates HGV prevalence, viral titers, and allograft histology in patients undergoing orthotopic liver transplantation (OLT) for cryptogenic cirrhosis.
Purpose of the Study:
- To determine the pre-OLT prevalence of HGV infection.
- To assess pre- and postoperative HGV viral titers.
- To evaluate allograft histology in HGV-infected OLT recipients.
Main Methods:
- HGV RNA quantification using a branched DNA assay targeting the 5'-untranslated region.
- Protocol liver biopsies for allograft histology in patients surviving beyond 6 months post-OLT.
Main Results:
- Preoperative HGV infection prevalence was 26% in recipients with cryptogenic cirrhosis.
- Mean HGV RNA levels increased from 9.8 x 10^6 eq/mL pre-OLT to 37.5 x 10^6 eq/mL at 1 year post-OLT.
- Hepatitis of uncertain etiology was observed in 60% of persistently HGV-infected cryptogenic recipients.
Conclusions:
- HGV infection prevalence is approximately 25% in OLT candidates for cryptogenic cirrhosis.
- Persistently infected recipients show increased HGV RNA titers post-OLT.
- About one-third of recipients clear detectable HGV RNA within the first month post-OLT.
Background:
The significance of hepatitis G (HGV) infection in liver transplant recipients is not known. We set out to determine the pre-orthotopic liver transplantation (OLT) prevalence, the pre- and postoperative viral titers of HGV, and the allograft histology in patients infected with HGV who underwent OLT for cryptogenic cirrhosis.
Methods:
HGV RNA was measured using a research-based branched DNA assay. The assay used a target-specific probe set that was based on the 5'-untranslated region of the HGV genome. Allograft histology was assessed with protocol liver biopsies in all patients who survived longer than 6 months.
Results:
The preoperative prevalence of HGV infection in recipients transplanted for cryptogenic cirrhosis was 26%. Thirty-seven percent (12 of 33) of recipients who had serum available in the first postoperative month had HGV infection. Mean HGV RNA levels were 9.8 (+/-4.2) (viral molecular equivalents/ml x 10[6]) before OLT and 37.5 (+/-10.7) at 1 year after OLT. In 4 of the 11 cryptogenic recipients in whom HGV RNA was detectable in the first postoperative month, HGV RNA fell to undetectable levels at the most recent follow-up (mean 70 months). Of the five cryptogenic recipients who continue to have measurable HGV RNA, three have unexplained hepatitis histologically.
Conclusions:
These findings suggest the following: 1) The prevalence of HGV infection in patients undergoing OLT for cryptogenic cirrhosis is about 25%. 2) In recipients persistently infected with HGV, mean HGV RNA titers increase after OLT. 3) HGV RNA becomes undetectable in about one third of recipients who had detectable HGV RNA in the first month after OLT. 4) Hepatitis of uncertain etiology occurs in 60% (3 of 5) of persistently HGV-infected cryptogenic recipients.