Clinicopathologic characteristics of patients with non-B non-C hepatitis virus hepatocellular carcinoma after hepatectomy

BackgroundA substantial population of hepatocellular carcinoma (HCC) patients is negative for markers of hepatitis B virus and hepatitis C virus (HCV) infection (non-B non-C hepatitis virus [NBC]).MethodsClinicopathologic data and outcomes were compared retrospectively for HCC patients with hepatitis B virus, HCV, and NBC who had undergone hepatectomy.ResultsThe TNM stage was significantly higher, and the prevalence of cirrhosis was significantly lower, in the NBC group compared with the HCV group. Among patients with a maximum tumor diameter of 5 cm or less, the survival rates were significantly higher in the NBC group than in the HCV group. Multivariate analysis revealed that preoperative serum des-gamma-carboxy prothrombin (DCP) level was a prognostic factor for survival in NBC–HCC patients. The DCP/tumor size ratio was significantly higher in NBC–HCC patients with normal liver histology than in patients with hepatitis or cirrhosis.ConclusionsNBC–HCC patients had more advanced tumors compared with HCV–HCC patients, but significantly higher survival rates. Measurement of DCP potentially is significant for early diagnosis of NBC HCC, which may increase the chance of curative therapy without recurrence.     

Hepatitis C Virus Infection is a Risk Factor for Tumor Recurrence after Resection of Small Hepatocellular Carcinomas

Hepatocellular carcinoma (HCC) is closely associated with chronic hepatitis B or C virus (HBV, HCV) infection. Tumor recurrence frequently occurs after surgical resection and may adversely affect the outcome. This study aimed to investigate the effect of viral hepatitis in association with HCC recurrence after resection. A total of 248 patients [HBV in 165, HCV in 44, dual HBV+HCV in 15, and non-B non-C (NBNC) in 24] who underwent curative resection for HCC were included. The cumulative recurrence rate was compared according to the etiology of the underlying hepatitis and was stratified by tumor size and other clinicopathologic parameters. Altogether, 116 patients (47%) had a tumor recurrence within 17 ± 11 months after resection. No significant difference in recurrence was noted among the four groups of patients (HBV, HCV, HBV+HCV, NBNC) (p = 0.248). Persistent hepatitis was more common in the HCV group (p < 0.001) after resection. Among the 157 patients with a small (= 5 cm) tumor, the recurrence rate was significantly higher in the HCV group than in the HBV, HBV+HCV, and NBNC groups (p = 0.036). Cox multivariate analysis showed that HCV infection [relative risk (RR) 4.4, 95% confidence interval (CI) 1.3–14.8, p = 0.018] and vascular invasion (RR 3.2, 95% CI 1.2–8.9, p = 0.044) were independent predictors of tumor recurrence. Stratified analysis in other parameters did not show significant differences in terms of tumor recurrence among the four virologic groups (p > 0.1 for all parameters). In conclusion, patients with small HCCs and concurrent HCV infection are at a high risk of tumor recurrence after resection.     

Hepatitis serology predicts tumor and liver-disease characteristics but not prognosis after resection of hepatocellular carcinoma

The impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection on survival rates after resection of hepatocellular carcinoma (HCC) is controversial. The objective of this study was to determine whether serologic evidence of HBV or HCV infection ("hepatitis serology") can predict underlying liver disease, tumor factors, and survival rates in patients with HCC. Using a multicenter international database, we identified 446 patients with complete HBV and HCV serology. One hundred twenty-six patients were negative for HBV and HCV, 163 patients had HBV infection only, 79 patients had HCV infection only, and 78 patients had coinfection with HBV and HCV. Patients with hepatitis were more likely to have tumors smaller than 5 cm and bilateral HCC involvement. Hepatitis status (negative vs. HBV vs. HCV vs. coinfection with HBV and HCV) did not predict tumor grade or the presence of multiple tumor nodules. Patients with HCV or coinfection with HBV and HCV exhibited a lower incidence of vascular invasion, but worse fibrosis than patients with negative serology or HBV. The median survival rate was 47.9 months. The presence of hepatitis did not significantly affect the survival rate, but hepatic fibrosis and vascular invasion predicted a decreased survival rate. The prognosis after resection of HCC is influenced by tumor factors and liver disease, but not by HBV or HCV infection. The treatment for HCC should be dictated by the extent of underlying liver disease rather than by hepatitis serology. Presented at the Forty-Fifth Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation).     

肝细胞肝癌与乙、丙及庚型肝炎病毒感染相关的组织学证据

目的探讨肝细胞肝癌（HCC）与乙、丙及庚型肝炎病毒（HBV，HCV，HGV）感染的相关性。方法采用免疫组化方法检测HCC患者癌及癌旁肝组织中HBV，HCV及HGV表达状况。结果65例HCC患者中，共计52例（80．0％）检出以上三种肝炎病毒抗原，其中乙型肝炎表面抗原（HBsAg），HCVNSS和HGVNSS抗原阳性者分别为47（72．3％），30（46．2％）和10（15．4％）例。52例病毒标志阳性者中，HBV，HCV和HGV三重感染者5例，HBV／HCV，HBV／HGV或HCV／HGV二重感染者各25例，单纯HBV和HCV阳性者各18例和4例，无单纯HGV阳性者。各病毒主要在癌旁组织中表达，但HBV和HCV在癌组织中也较活跃。此外，间或可在肿瘤与正常组织移行处检出HBV或HCV表达，但未见HGV抗原阳性。混合感染、单独感染及病毒标志阴性的HCC比较，肿瘤分化程度无明显区别。结论我国HCC患者肝炎病毒混合感染普遍存在；除HBV和HCV外，HGV感染也可能与肝癌发生有一定关系。     

Clinical characteristics of hepatitis B core antibody-positive hepatocellular carcinoma

The pathology and prognosis of hepatitis B surface antigen (HBsAg)-positive hepatocellular carcinoma (HCC) and hepatitis C virus antibody (HCVAb)-positive HCC is well documented. However, patients with HBsAg-negative/hepatitis B core antibody (HBcAb)-positive HCC are included with non-B non-C disease and have been characterized independently. A series of 125 patients who had undergone hepatectomy for HCC were divided into three groups and compared. The HBsAg group comprised 25 HBsAg-positive patients, the HCV group comprised 70 HCVAb-positive patients, and the HBcAb group comprised 22 HBcAb-positive/HBsAg-negative patients. Eight patients of negative virus markers were excluded in this study. Tumors were larger in the HBcAb group (6.2 cm) than in the HBsAg (4.4 cm) and HCV (3.7 cm) groups. Disease-free 1-, 3-, and 5-year survival rates were, respectively, 75.0%, 57.1%, and 57.1% in the HBcAb group; 60.9%, 41.8%, and 41.8% in the HBsAg group; and 88.0%, 54.0%, and 37.8% in the HCV group. HBcAb-positive HCC patients had larger tumors, but their prognosis was relatively good. Although HBsAg and HCVAb are used for conventional screening of patients with hepatic disorders, we believe that screening is also necessary in patients with positive HBcAb titers for early detection of HCC.     

Comparison of Surgical Outcomes for Hepatocellular Carcinoma in Patients With Hepatitis B Versus Hepatitis C: A Western Experience

Background: We reviewed our experience in patients with hepatocellular carcinoma (HCC) and chronic hepatitis to determine if differences exist in preoperative status and postoperative survival between those with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.Methods: We reviewed the records of 240 consecutive patients with HCC who underwent hepatic resection or liver transplantation at Mount Sinai Hospital between February 1990 and February 1998. Patients who tested negative for hepatitis B antigen and hepatitis C antibody (74 patients) as well as those who tested positive for both (2 patients) were excluded. Age as well as preoperative platelet count, prothrombin time (PT), albumin, and total bilirubin were measured in all patients. The presence of encephalopathy or ascites also was noted. Explanted livers and resection specimens were examined for size, number, and differentiation of tumors as well as the presence of vascular invasion and cirrhosis in the surrounding parenchyma.Results: One hundred twenty-one patients with HCC tested positive for HCV, and 43 tested positive for HBV. A significantly higher proportion of patients with HCV required transplant for the treatment of their HCC when compared to those with HBV. In the resection group, patients with HCV were significantly older that those with HBV. They also had significantly lower mean preoperative platelet counts and albumin levels and higher mean PT and total bilirubin levels. Resected patients with HCV had significantly less-differentiated tumors and a higher incidence of vascular invasion and cirrhosis when compared to those with HBV. There was no statistical difference in the multicentricity and size of tumors between the two groups. The 5-year disease-free survival was significantly higher for HBV patients treated with resection when compared to those with HCV (49% vs. 7%, P 5 .0480). Patients with HCC and HCV had significantly longer 5-year disease-free survival with transplant when compared to resection (48% vs. 7%, P 5 .0001).Transplanted patients with HBV and HCC had preoperative status, pathological findings, and survival similar to those of patients with HCV.Conclusions: Based on preoperative liver function and tumor location, a much higher proportion of HCC patients with HBV were candidates for resection. Significant differences in preoperative status, tumor characteristics and disease-free survival exist between HCC patients with chronic HBV and HCV infection who have not yet reached end-stage liver disease. Serious consideration should be given to transplanting resectable HCC with concomitant HCV, especially in cases with small tumors.Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.     

乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

【摘要】〓目的〓探讨乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。方法〓收集2003年12月~2010年10月在南方医科大学附属南方医院行手术治疗C-HCC标本18例和2011年3月~2012年12月行手术治疗的B-HCC标本34例,以及这些肝癌患者的临床病理资料。分析乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。结果〓乙肝相关性肝癌平均年龄(46.9±10.5)显著低于丙肝相关性肝癌组(59.0±9.9),平均住院天数(17.9±6.8)显著低于丙肝相关性肝癌组(34.9±16.5),平均术后住院天数(11.5±4.3)显著低于丙肝相关性肝癌组(19.4±11.9),肝功能分级中A级肝功明显较丙肝相关性肝癌组多,最大肿瘤直径明显大于丙肝相关性肝癌组,差异均有统计学意义(P<0.05)。B-HCC组患者中位无瘤生存时间为13个月,1年、2年无瘤生存率分别为56.3%和32.0%;C-HCC组患者中位无瘤生存时间为16.5个月,1年、2年无瘤生存率分别为75%和75%。Cox模型分析提示肝炎类型是肝细胞癌术后复发的独立影响因素。乙肝相关肝细胞癌术后复发的风险是丙肝相关性肝癌的2.35倍(P=0.108)。结论〓乙肝病毒与丙肝病毒相关肝细胞癌的临床病理特征及预后有显著差异。乙肝相关性肝癌术后恢复较丙肝相关性肝癌快,而丙肝相关肝细胞癌术后复发风险低于乙肝相关肝细胞癌。     

维持性血液透析患者感染乙型和丙型肝炎的分析

目的为了评价血液透析（血透）患者乙型和丙型肝炎（HBV、HCV）感染状态及对临床情况和肝功能的影响。方法对62例血透患者应用ELISA法和RT-PCR法检测抗-HCV和HCVRNA，采用斑点杂交法和固相放免法检测HBV标志，并检测肝功能和血浆蛋白电泳。结果62例患者中，抗-HCVIgM阳性27例（43．6％），抗-HCVIgG阳性29例（46．8％），HCVRNA阳性34例（54．8％），三项任一项阳性37例（59．7％），5例（8．1％）HBsAg阳性，其中HBeAg和HBVDNA阳性3例。结论向透患者中HCV感染严重，临床情况及预后差，检测血浆蛋白和电泳较肝功能酶学能更好地作为肝炎诊断和反映病情的指标。     

乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者存活的影响

目的探讨乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(hepatitis C virus,HCV)感染对肾移植受者长期存活的影响及预防措施。方法 HBV和(或)HCV感染肾移植受者110例(感染组),其中HBV感染受者56例、HCV感染受者52例,HBV与HCV合并感染2例。非HBV与非HCV感染受者694例(非感染组)。感染组受者术前有病毒复制者予积极治疗,研究早期肝功能正常者可接受肾移植,后期均用聚合酶链反应(PCR)检测,要求连续3～6个月HBV脱氧核糖核酸(DNA)0copy/ml,HCV核糖核酸(RNA)0copy/ml方可接受肾移植。术后定期检测HBV与HCV,定期检测感染组受者HBVDNA滴度、HCVRNA滴度。发现HBV复制,选用拉米夫定、阿德福韦酯治疗,酌情减少免疫抑制剂用量。分别比较两组术后1、3、5年人、肾存活率,比较两组的肝功能衰竭病死率。结果非感染组人、肾存活率分别为:1年94.2%、91.4%,3年为86.4%、85.2%,5年为82.7%、78.9%;感染组人、肾存活率分别为:1年90.2%、88.1%,3年为88.9%、86.2%,5年为81.5%、76.3%;两组数据比较差异均无统计学意义(均为P>0.05)。感染组中14例(12.7%)死于肝功能衰竭,其中10例为HBV感染者,非感染组受者无1例死于肝衰竭。感染组术后肝衰竭病死率明显高于非感染组(12.7%、0,P<0.05)。结论受者术前HBV和(或)HCV感染会明显增加肾移植术后肝衰竭死亡危险。患者术前处于病毒复制期应予积极治疗,在肝炎病毒停止复制6个月后再考虑肾移植。长期随访中应定期复查HBV与HCV感染指标,早确诊、早治疗,并及时调整免疫抑制剂剂量。     

Occult HBV Infection in Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients

Aim. Occult hepatitis B virus (HBV) infection can be defined as the presence of HBV DNA in the liver and/or blood in the absence of detectable serum hepatitis B surface antigen (HBs Ag). There is a high prevalence of occult HBV infection in dialysis patients. This study investigated the prevalence of occult HBV infection in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients and compared the prevalence of occult HBV infection in dialysis patients either with or without hepatitis C virus (HCV) infection.?Methods.?In this cross-sectional study, 71 CAPD patients and 71 HD patients were evaluated. HBV DNA testing was performed by polymerase chain reaction (PCR). We recorded general characteristics of the patients, duration of dialysis, HBs Ag, antibody to hepatitis B surface antigen (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), anti-HCV antibody (anti-HCV), HCV RNA, serum alanine aminotransferase (ALT), and aspartate aminotransferase levels (AST).?Results.?Twelve (16.9%) of the 71 HD patients and seven (9.8%) of the 71 CAPD patients were HBV DNA-positive. A statistically significant difference was not observed in the groups. Anti-HCV was negative and AST and ALT levels were normal in all of the HBV-DNA positive patients. Viral loads were low in both groups. Conclusion. This is the first study that analyzes occult HBV prevalence in CAPD patients. We conclude that the prevalence of the occult HBV may be common in CAPD patients as in HD patients, and HCV positivity is not a contributing factor to occult HBV infection in dialysis patients.     

Impact of statin use on the prognosis of patients with hepatocellular carcinoma undergoing liver resection: a subgroup analysis of patients without chronic hepatitis viral infection

Background

Statins have been reported to reduce the risk of hepatocellular carcinoma (HCC). The effect of perioperative statin use on the prognosis of HCC patients undergoing liver resection remains unclear.

Liver Retransplantation in Patients With HIV‐1 Infection: An International Multicenter Cohort Study

Liver retransplantation is performed in HIV‐infected patients, although its outcome is not well known. In an international cohort study (eight countries), 37 (6%; 32 coinfected with hepatitis C virus [HCV] and five with hepatitis B virus [HBV]) of 600 HIV‐infected patients who had undergone liver transplant were retransplanted. The main indications for retransplantation were vascular complications (35%), primary graft nonfunction (22%), rejection (19%), and HCV recurrence (13%). Overall, 19 patients (51%) died after retransplantation. Survival at 1, 3, and 5 years was 56%, 51%, and 51%, respectively. Among patients with HCV coinfection, HCV RNA replication status at retransplantation was the only significant prognostic factor. Patients with undetectable versus detectable HCV RNA had a survival probability of 80% versus 39% at 1 year and 80% versus 30% at 3 and 5 years (p = 0.025). Recurrence of hepatitis C was the main cause of death in the latter. Patients with HBV coinfection had survival of 80% at 1, 3, and 5 years after retransplantation. HIV infection was adequately controlled with antiretroviral therapy. In conclusion, liver retransplantation is an acceptable option for HIV‐infected patients with HBV or HCV coinfection but undetectable HCV RNA. Retransplantation in patients with HCV replication should be reassessed prospectively in the era of new direct antiviral agents.     

不明原因肝病患者肝组织HBV及HCV抗原的检测及临床和病理特点

目的了解不明原因肝病患者中HBV及HCV隐匿性感染所占的比例及临床、病理特点。方法对31例不明原因肝病患者,采用酶联免疫吸附试验（ELISA）检测血清乙型肝炎病毒标志物（HBV-M）（HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc）及丙型肝炎病毒抗体;血清HBV DNA采用荧光定量PCR法检测,HCV RNA采用RT-PCR法检测;应用免疫组织化学二步法检测肝组织中的HBsAg、HBcAg、HCV抗原,并进行常规病理检查。结果肝组织HBV抗原阳性者11例（35.5%）;HBV、HCV抗原均阳性者10例（32.3%）,全阴性者10例（32.3%）。存在HBV隐匿性感染的21例患者中,慢性肝炎患者7例,肝硬化患者12例,肝细胞性肝癌患者2例。结论HBV、HCV感染为不明原因肝病的主要原因,尤其是HBV感染。HBV隐匿性感染与慢性肝炎、肝硬化、肝癌关系密切,应引起重视。     

Chronic Viral Hepatitis and Hepatocellular Carcinoma

Background Hepatocellular carcinoma (HCC) is the third leading cause of death from malignancy worldwide, and its increasing incidence parallels rising global rates of hepatitis B (HBV) and hepatitis C (HCV). Methods This retrospective review was undertaken to identify differences in the epidemiology and tumor characteristics of 255 patients with HCC due to chronic HBV (n = 105) or HCV (n = 150). Results Hepatitis B patients were predominantly Asian (84%), whereas HCV patients were predominantly Caucasian (72%; p < 0.0001). Hepatitis B patients exhibited stronger family histories of liver disease (54%) and HCC (33%), whereas HCV risk factors included blood transfusion (56%), intravenous drug abuse (31%), and alcohol consumption (44%; p < 0.0001 for all comparisons). Pretreatment laboratory values showed lower albumin and platelet levels but higher bilirubin and AST levels in HCV versus HBV patients (p < 0.0001 to 0.01). As cirrhosis was present in nearly all HCV patients, but only in 79% of HBV patients, HCV patients had more stigmata of portal hypertension, including ascites (65%), varices (86%), splenomegaly (77%), and encephalopathy (41%; p < 0.0002 for all comparisons). Although tumors in HBV patients were larger (7.3 cm versus 5.1 cm; p = 0.0001) and more frequently bilobar, the tumor grade, number of tumors, and metastases were similar for both groups. Hepatitis C patients received less treatment, including chemoembolization and surgical resection. The 5-year survival was higher in HBV patients compared to HCV patients (56% versus 36%, p = 0.046). Conclusions Patients with HBV- and HCV-related HCC have different epidemiologic, clinical, and survival characteristics. More HCV patients presented with advanced cirrhosis, received less aggressive treatment, and experienced lower 5-year survival.     

Incidence and clinical relevance of recurrent hepatitis C infection after orthotopic liver transplantation

Abstract From September 1988 to November 1992 318 liver transplants were performed at our hospital. Of these patients 68 had end-tage cirrhosis due to non-A, non-B, hepatitis, 44 of whom (64.7%) had hepatitis C virus RNA in the serum. Of this subgroup 35 patients (79.5%) were also anti-HCV positive. Postoperatively most recipients remained anti-HCV positive and after 1 year more than 90% had HCV RNA in the serum. About 40% developed a mild, chronic hepatitis and 50% were carriers of HCV without histo-pathological signs. Two patients suffered from a temporary severe acute hepatitis and one patient had a fulminant liver failure due to reinfection. In general, in liver recipients transplanted for end-tage HCV hepatitis there was a high incidence of reinfection with HCV. The clinical course, however, was less severe than in hepatitis B recurrence.     

Longer survival of liver transplant recipients with hepatitis virus coinfections

Hepatitis virus coinfections [HBV plus HCV coinfection (HBV/HCV) or HBV plus HDV coinfection (HBV/HDV)] may progress more rapidly to cirrhosis than hepatitis B or C monoinfections in immunocompetent patients. Only limited information is available on the outcome of coinfected patients after liver transplantation. We studied survival rates of 204 patients with viral hepatitis transplanted at our center between 1972 and 1997. HBV/HDV and HBV/HCV coinfections were present in 23 and nine individuals, respectively, while 97 patients had monoinfection by HCV and 75 had HBV monoinfection. Survival of coinfected patients was significantly longer than that of monoinfected patients (14.4 +/- 0.9 vs. 8.5 +/- 0.6 yr; p = 0.0003). The same was true for graft survival (p = 0.0002). In Cox's regression, viral coinfection (p = 0.0001), absence of hepatocellular carcinoma (HCC) (p = 0.00001) and no retransplantation (p = 0.02) were independently associated with patient survival. After exclusion of patients with HCC (n = 62), survival of coinfected patients was still significantly longer than that of monoinfected individuals (p = 0.002). The improved outcome was similar for both HBV/HDV and HBV/HCV coinfections. In contrast to immunocompetent patients, individuals with multiple hepatitis virus infections had an improved outcome after liver transplantation. Thus, viral coinfections may be associated with ameliorated courses of diseases under certain conditions.     

Antihepatitis C virus status in hepatocellular carcinoma and the influence on clinicopathological findings and operative results.

Antihepatitis C virus (HCV) status was investigated in 100 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) between 1980 and 1989. The clinicopathological findings and operative results, in patients with or without HCV marker, were compared retrospectively. The positivity rate of anti-HCV was 51 per cent. In this group there was a higher mean age, fewer symptoms, raised alanine aminotransferase level, higher 15-min indocyanine green clearance rate and earlier tumour stage compared with the anti-HCV negative group. Positive tumour margins and vascular invasion were seen less frequently in the anti-HCV positive group. HCC with HCV marker showed characteristic features of chronic non-A non-B hepatitis and of HCC originating from liver cirrhosis. There was a better cumulative 1-year survival rate for anti-HCV positive patients, but 3- and 5-year survival rates after hepatectomy were similar in both groups. Although HCV-related HCC had typical features of chronic non-A non-B hepatitis and a relatively early stage of tumour, biological features and operative results were similar with or without the HCV marker.     

聚合酶链反应用于肝硬变门静脉高压症病原学研究

应用聚合酶链反应（ＰＣＲ）及酶联免疫吸附试验（ＥＬＩＳＡ）检查发现：肝硬变门静脉高压症处于乙型肝炎病毒（ＨＢＶ）、丙型肝炎病毒（ＨＣＶ）感染状态的比率分别为８０．７％及３７．８％；处于ＨＢＶ、ＨＣＶ活跃复制状态的比率分别为３１．６％及２９．８％。ＨＢＶ、ＨＣＶ感染指标至少有一项阳性的比率为８６．７％。手术治疗组及内科治疗组病人的乙型肝炎血清标志及丙型肝炎感染状态比较均无显著性差异。ＨＣＶＲＮＡ及Ｈ     

Hepatitis G virus infection in a haemodialysis unit: prevalence and clinical implications

Background. Hepatitis viruses have become one of the main infectious problems in patients on long-term haemodialysis. A new RNA virus, designated hepatitis G virus (HGV) has been recently identified. The pathogenic relevance of this virus is currently under investigation. The aim of this study was to analyse the prevalence and clinical implications of hepatitis G virus infection in patients on haemodialysis. Methods. The presence of HGV-RNA was investigated in 96 patients on maintenance haemodialysis. Hepatitis viral markers (HBsAg, anti-HCV, HGV-RNA) and liver tests were assessed in all these patients, as well as the risk factors for hepatitis viruses acquisition. As a control group, 200 blood donors were tested for the presence of HGV-RNA. Results. HGV-RNA was detected in 25 of 96 patients on haemodialysis (26%) and in six of 200 blood donors (3%) (P <0.001). Thirteen of 25 HGV infected patients (52%) were coinfected with other hepatitis viruses (HBV and/or HCV). Evidences of chronic liver disease were more frequent in patients infected by HBV and/or HCV (61%) than in patients infected by HGV alone (17%) (P = 0.01). Although 80% of HGV infected patients had received blood products, the transfusion rate was not different from non HGV-infected patients. Time on haemodialysis was significantly shorter in patients infected with HGV alone (3.1 ± 3.5 years) compared to patients infected with HBV and/or HCV (7.6 ± 5.8 years) (P = 0.04). Conclusions. Patients on maintenance haemodialysis are at increased risk for HGV infection. HGV infection itself does not seem to be a frequent cause of chronic liver disease in these patients. Since the prevalence of HGV infection in blood donors is high, blood transfusions could be one of the main factors implicated in HGV transmission in patients on haemodialysis.     

Chronic liver dysfunction in heart transplant recipients, with special reference to viral B, C, and non-A, non-B, non-C hepatitis. A retrospective study in 80 patients with follow-up of 60 months

In order to assess the prevalence, causes, and severity of chronic liver dysfunction (LD) in heart transplant patients, 80 transplanted patients followed for 60 months (median; range, 1.5-98 months) were reviewed. Sustained liver dysfunction was found in 50 patients, occurring during the first year after heart transplantation in 42 (84%) of them. Most patients were asymptomatic (80%). Causes for the liver dysfunction included non-A, non-B hepatitis in 16 cases (32%), viral B hepatitis in 13 (26%), delta hepatitis in one (2%), drug-induced hepatitis in six (12%), and cardiac failure in seven (14%). Anti-HCV antibodies were found in 56.2% of patients with non-A, non-B hepatitis and in 22% of patients with HBV hepatitis. It was found neither in patients with drug-induced hepatitis cardiac failure nor in patients with normal liver tests. This study outlines a high prevalence of LD (62.5%) in heart transplant patients, the high frequency of viral-related chronic LD (usually of moderate severity), and high incidence of HCV and HBV hepatitis.