A prospective study of post‐transfusion non‐A, non‐B (type C) hepatitis following cardiovascular surgery in Taiwan

Abstract

In an attempt to investigate the incidence and clinical course of non-A, non-B (NANB) hepatitis following blood transfusion in Taiwan, 288 patients who underwent cardiovascular surgery and received blood transfusion were followed prospectively with serum liver aminotransferase levels and viral hepatitis markers for at least six months. None had any past history of liver disease or drug abuse. All blood donors were tested for serum hepatitis B surface antigen and alanine aminotransferase (ALT) (greater than 45 U/L). Thirty-seven (12.8%) patients developed PTH. 34 (91.9%) were considered to be cases of NANB hepatitis, 2 (5.4%) were cytomegalovirus hepatitis, and one (2.7%) was caused by Epstein-Barr virus. No one developed hepatitis B post-transfusion hepatitis (PTH). Of the 34 NANB PTH patients, 15 (44.1%) were asymptomatic, 16 (47.1%) had clinical symptoms, and 9 (26.5%) had serum total bilirubin levels higher than 2 mg/dl. There was no case of fulminant hepatic failure. Of 26 NANB PTH patients who were followed up for more than one year, 15 (57.7%) still had abnormal serum ALT levels. The incubation period of NANB PTH ranged from 2 to 16 (mean 6.1 +/- 3.2) weeks. Of the 37 PTH patients, 32 (86.5%) were found to have anti-HCV seroconversion during one year follow-up period. NANB PTH is as common in Taiwan as in the United States and Japan, and is demonstrated by this study to be due mostly to HCV.

Comparison of clinical, virologic and pathologic features in patients with acute hepatitis B and C

“…Patients with acute hepatitis C were enrolled from a prospective study of post‐transfusion non‐A, non‐B hepatitis, who underwent cardiovascular surgery and received blood transfusions. Acute hepatitis C was defined as two consecutive serum alanine transaminase (ALT) levels elevated above 90 U/L (twice the upper normal limit), at least twice at longer than 2 week intervals, and the seroconversion of serum anti‐HCV or detectable serum HCV‐RNA after a blood transfusion 7,8 . Acute viral hepatitis B was defined by the presence of positive serum hepatitis B surface antigen (HBsAg) and IgM anti‐HBc in patients with an acute onset of ALT elevation.…”

“…[1][2][3] Patients with acute hepatitis C are difficult to diagnose because of the lack of an acute seromarker, such as immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc), in diagnosing patients with acute hepatitis B. Patients with acute HCV infection diagnosed by using the seroconversion of antibody to HCV (anti-HCV) or HCV-RNA, 7,8 who were prospectively followed in a post-transfusion hepatitis study, are the gold standards in evaluating the clinical, virologic and histological manifestations of acute HCV infection.…”

Hepatitis C virus infection‐related Type 1 diabetes mellitus

“…In 1987, a 66-year-old Taiwanese man was enrolled in a prospective study of post-transfusion non-A-non-B hepatitis. According to the study protocol, blood specimens were collected before surgery, 3 days after transfusion and then weekly in the first month, biweekly in the next 2 months and monthly in the next 9 months [20,21]. All specimens were preserved at −70 °C.…”

Incidence of Post-Transfusion Hepatitis before and after Screening for Hepatitis C Virus Antibody

“…However, 12.8% of patients receiving blood transfusion still devel oped post-transfusion hepatitis (PTH). Of them, 86.5% were attributed to HCV infection, but none developed PTH B [11], Therefore, transfusion-related hepatitis B can be ef fectively prevented by this screening method but HCV in fection is the most common étiologie agent of PTH.…”

“…In May 1988, the genome of a major NANB hepatitis agent [hepatits C vims (HCV)] was cloned and a serological test for detection of antibody to HCV (anti-HCV) was also developed [5,6]. In most cases, post-transfusion NANB hepatitis seems to be caused by HCV infection [7][8][9][10][11], From June 1989 to April 1993, 313 patients who underwent cardio vascular surgery and received blood transfusion were followed pro spectively for at least 6 months. Patients with known liver diseases and abnormal ALT levels before blood transfusion were excluded.…”