Long-term clinical and histopathological follow-up of chronic posttransfusion hepatitis

Bisceglie, Adrian M. Di; Goodman, Zachary; Ishak, Kamal G.; Hoofnagle, Jay H.; Melpolder, Jacqueline J.; Alter, Harvey J.

doi:10.1002/hep.1840140603

Cited by 484 publications

(167 citation statements)

References 19 publications

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“…Results of liver biopsies were available for 20 of 70 patients with PCT (16 HCV-positive) and 13 of 15 PCT-negative patients with chronic hepatitis C. On the whole, the biopsies showed mild to moderate fibrosis, fatty change, iron deposition, hepatocyte necrosis, piecemeal necrosis, and lympho-histiocytic infiltration of portal tracts, in keeping with previous reports of changes in PCT [1][2][3]20 or chronic hepatitis C. 33,34 Seven of the 16 HCV-positive PCT patients had moderate (2-3ϩ) fibrosis, and none had cirrhosis (4ϩ fibrosis), whereas none of the 4 PCT patients who were HCV-negative had moderate fibrosis (2 had 0 and 2 had 1ϩ fibrosis). Two patients in each group had heavy (3-4ϩ) iron staining.…”

Section: Table 4 Prevalence Of Increased Serum Transferrin Saturatiosupporting

confidence: 84%

Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in north america†

et al. 1998

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In some, but not all countries, porphyria cutanea tarda (PCT) has been associated with chronic infection with the hepatitis C virus (HCV). Recently, PCT has also been associated with mutations in the HFE gene that are associated with HLA-linked hereditary hemochromatosis. Until now, few studies of these associations have been reported from North America. The aims of this study were: 1) to assess the prevalence of HCV infection and HFE mutations in North American patients with PCT; 2) to compare demographic and laboratory features between those who are HCV-positive and HCV-negative; and 3) to study urinary porphyrin excretions in American HCV-positive patients without clinically manifest PCT. Clinical and laboratory data, including tests for HCV and urinary porphyrins, were collected from 70 unselected patients with typical PCT. Urinary porphyrins were also measured in 110 non-PCT patients with chronic hepatitis C. Mutational analyses of the HFE gene were performed in 26 PCT patients. Thirtynine of 70 (56%) of the PCT patients had evidence of HCV infection. Thirty-two of 39 PCT patients with HCV were men, all of whom used alcohol. In contrast, 22 of 31 PCT patients without HCV infection were women, 12 of whom had taken estrogens. The HCV-positive group was more likely to have used illicit intravenous drugs (45% vs. 0%; P ‫؍‬ 0.01), to have had several (G4) sex partners (48% vs. 13%; P ‫؍‬ 0.005), and less likely to have no known risk factors for HCV infection (33% vs. 78%; P ‫؍‬ 0.004). Total urinary porphyrin excretion was the same in the two groups, but those with HCV infection had a significantly lower percentage of uroporphyrin and higher percentages of hepta-and hexa-carboxy porphyrins in urine. Sixteen of 110 (15%) HCV-positive subjects without PCT had increased urinary porphyrins, but, unlike PCT, these were mainly coproporphyrin. Forty-two percent of PCT patients carried the C282Y mutation of HFE (15% homozygous), and another 31% carried the H63D mutation (8% homozygous). Thus, 73% of PCT patients had one of these mutations. The prevalence of HCV infection (56%) and mutations in the HFE gene (73%) are high among North American patients with PCT. Alcohol and estrogen use are important additional risk factors. All PCT patients should be tested for HCV infection and for HFE gene mutations. Although HCV infection is a trigger for PCT, preclinical PCT is rare in chronic HCV hepatitis C in the United States. (HEPATOLOGY 1998;27:1661-1669.)

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Section: Table 4 Prevalence Of Increased Serum Transferrin Saturatiosupporting

confidence: 84%

Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in north america†

et al. 1998

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“…Some patients developed cirrhosis, often within a very short time. 2 We now know that HCV is distributed worldwide and accounts for a substantial proportion of chronic liver disease. In the United States, chronic hepatitis C represents a large health care burden because of the associated symptoms, extrahepatic manifestations, and the complications of cirrhosis.…”

Section: Adrian M Di Biscegliementioning

confidence: 99%

Natural history of hepatitis C: Its impact on clinical management

2000

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“…25 Chronic alcohol abuse appears to accelerate this process. 26 Although patients with well-compensated cirrhosis have an estimated 10-year survival rate greater than 80%, once complications develop, the 5-year survival rate decreases to less than 50%.…”

Section: Chronic Hepatitismentioning

confidence: 99%

Liver transplantation

Carithers

2000

Liver Transpl

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Liver transplantation has revolutionized the care of patients with end-stage liver disease. Liver transplantation is indicated for acute or chronic liver failure from any cause. Because there are no randomized controlled trials of liver transplantation versus no therapy, the efficacy of this surgery is best assessed by carefully comparing postoperative survival with the known natural history of the disease in question. The best examples of this are in primary biliary cirrhosis and primary sclerosing cholangitis, for which well-validated disease-specific models of natural history are available. There are currently relatively few absolute contraindications to liver transplantation. These include severe cardiopulmonary disease, uncontrolled systemic infection, extrahepatic malignancy, severe psychiatric or neurological disorders, and absence of a viable splanchnic venous inflow system. One of the most frequently encountered contraindications to transplantation is ongoing destructive behavior caused by drug and alcohol addiction. The timing of the surgery can have a profound impact on the mortality and morbidity of patients undergoing liver transplantation. Because of the long waiting lists for donor organs, the need to project far in advance when transplantation might be required has proven to be one of the greatest challenges to those treating patients with end-stage liver disease. Three important questions must be addressed in a patient being considered for liver transplantation: (1) when should the patient be referred for possible transplantation? (2) when should the patient be listed for transplantation? and (3) when is the patient too sick to have a reasonable chance of surviving the perioperative period?

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Long-term clinical and histopathological follow-up of chronic posttransfusion hepatitis

Cited by 484 publications

References 19 publications

Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in north america†

Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in north america†

Natural history of hepatitis C: Its impact on clinical management

Liver transplantation

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