Long‐term follow‐up of chronic post‐transfusion non‐A, non‐B hepatitis: clinical and histological outcome

Abstract

~ A chart review of chronic hepatitis cases at the Department of Infectious Diseases, Roslagstull Hospital, Karolinska Institute, Stockholm, Sweden, revealed 37 patients with chronic non-A, non-B hepatitis, caused by blood transfusions or intravenous gammaglobulin infusions. They had been followed up long-term, mean 46 months (range 1&149). During the initial hepatitis episode most patients had been anicteric and 13/37 (35%) asymptomatic. Yet, the majority developed progressive liver disease with chronic active hepatitis, with or without histological signs of cirrhosis. Thus, l0/18 (56%) on whom a liver biopsy had been performed within 7-12 months had chronic active hepatitis, four (22%) with histological signs of cirrhosis, and of the five patients biopsied after 2 5 years of follow-up, three (60%) had histological signs of cirrhosis. Accordingly, as the duration of follow-up increases, an increasing number of patients with post-transfusion non-A, non-B hepatitis seem to develop cirrhosis.

Application of a numerical scoring system for assessment of histological outcome in patients with chronic posttransfusion non‐A, non‐B hepatitis with or without antibodies to hepatitis C

“…Although CPH is thought to be a nonprogressive disease (1 7, 22), we have noticed progression of CPH to CAH/eCi and CAH/Ci (2). When applying the scoring system to these liver specimens initially diagnosed as CPH, mild PMN was in fact present, and they could equally well have been classified as cases of mild CAH, a subgroup that seems to be motivated to use in routine diagnosis.…”

“…The long-term prognosis of chronic posttransfusion NANB hepatitis has been shown to be serious with an increasing number of patients eventually developing cirrhosis (1,2). In this study, biopsy specimens from only 2 of 19 patients Table 3 Conventional histological classification in the latest liver biopsy from 37 patients with chronic posttransfusion non-A, non-B hepatitis according to reactivity (pos) or not (neg) for serum antibodies to hepatitis C virus antibody (anti-HCV) correlated to the fibrosis and piecemeal necrosis score values (1 1 %) showed histological improvement during follow-up, whereas 10 (53%) displayed deterioration as judged by the conventional histological classification (p < 0.05; sign test).…”

“…Thirty-seven patients, 19 men and 18 women (mean age 54 years, range 18-83), with clinical, biochemical, serological and histological findings consistent with chronic NANB hepatitis, developed after blood transfusions (33 cases) or intravenous immunoglobulin administration (4 cases), were followed long-term (mean 51 months, range 14-149). The clinical and histological findings for these patients, classified in a conventional manner, have previously been reported (2). Further follow-up biopsies have been obtained and are included in the present study.…”

“…Among patients with transfusion-associated chronic non-A, non-B (NANB) hepatitis, chronic active hepatitis (CAH) is the most common descriptive histological finding. Eventually, 1 &20% will develop liver cirrhosis (1,2).…”

Histological outcome in patients with chronic hepatitis C given a 60‐week interferon alfa‐2b treatment course

“…Most importantly, we found a significant improvement for all histological categories scored in the posttreatment liver biopsy among patients responding to the prolonged interferon course with sustained normalization of s-ALT levels and eradication of the viremia. These findings are important, since the liver histological changes in untreated patients with chronic hepatitis C are often progressive, although the disease is mostly mild and clinically asymptomatic for prolonged time periods (1)(2)(3)(4). An effective anti-viral treatment for chronic hepatitis C is thus needed.…”