Correspondence

Hepatitis G Virus and Post-Transplantation Hepatitis

N Engl J Med 1996; 335:1394-1395October 31, 1996

Article

To the Editor:

Hepatitis G virus (HGV), a newly discovered hepatotropic flavivirus1 that can induce persistent infection, has been associated with acute and chronic liver disease.2,3 There are only limited data concerning the prevalence of HGV in patients undergoing orthotopic liver transplantation,4 and the role of HGV in post-transplantation hepatitis is unknown. To address these issues, we studied 86 patients with cirrhosis who underwent liver grafting in 1992 to 1995.

Forty-five patients had cirrhosis related to hepatitis C virus (HCV), 17 had cirrhosis related to hepatitis B virus (HBV), 13 had alcoholic cirrhosis, and 11 had cryptogenic cirrhosis. Serum samples, obtained on the day of transplantation and 6 to 12 months later, were frozen at -80°C and retrospectively tested for HGV RNA by a reverse-transcription polymerase-chain-reaction (PCR) assay that detects sequences in the nonstructural region 3 (helicase region) of the virus.3 Results were confirmed by cloning and sequencing PCR products and by amplification with primers from the 5' noncoding region. All patients underwent liver biopsy when clinically indicated and at yearly intervals. Follow-up lasted 6 to 52 months (mean, 28).

The prevalence of HGV infection before and after transplantation in the four groups of patients is shown in Table 1Table 1Prevalence of HGV Infection before and after Transplantation and of Post-Transplantation Hepatitis.. All patients who were HGV-positive before transplantation had persistent infection after grafting, and in some patients who were HGV-negative before transplantation detectable viremia developed only after transplantation. Patients with post-transplantation hepatitis who were HGV-positive had concurrent infections with either HCV or HBV (Table 1). In patients who were coinfected with HCV and HGV, the frequency of post-transplantation hepatitis was similar to that in patients with HCV infection alone (58 percent vs. 54 percent),5 suggesting that HGV infection had a minor role in post-transplantation hepatitis in these patients. Coinfection with HGV did not influence the clinical manifestations of post-transplantation hepatitis.

We conclude that HGV infection is frequent among patients with cirrhosis who undergo liver transplantation, that infection with the virus persists after grafting but does not seem to be associated with recurrent liver disease, and that HGV viremia is detectable in a large proportion of patients only after transplantation. Whether this last finding reflects reactivation or spontaneous acquisition of the infection is unknown.

Luca S. Belli, M.D.
Gaetano Idéo, M.D.
Ospedale Niguarda, 20162 Milan, Italy

Enrico Silini, M.D.
Ospedale San Matteo, 27100 Pavia, Italy

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Citing Articles (15)

Citing Articles

1. 1

   Shigenobu Takayama, Takuma Miura, Tomonari Tominaga, Masashi Taki, Sumitaka Matsuo, Shunji Sugii, Kunitada Shimotohno. (1999) Partial nucleotide sequencing of the NS3/helicase region of hepatitis G virus to prove vertical transmission. FEMS Microbiology Letters 175:2, 273-279
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   ORIT ELKAYAM, HOWAYDA M. HASSOBA, LINDA D. FERRELL, RICHARD GARCIA-KENNEDY, ROBERT G. GISH, TERESA L. WRIGHT, TOM LAFFLER, DENA TRAYLOR, GEFFREY HUNT, PHILIP ROSENTHAL. (1999) GB Virus C (GBV-C/HGV) and E2 Antibodies in Children Preliver and Postliver Transplant. Pediatric Research 45:6, 795-798
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   Lionel Rostaing, Jacques Izopet, Catherine Arnaud, Jean-Marc Cisterne, Laurent Alric, Jean-Louis Rumeau, Michel Duffaut, Dominique Durand. (1999) LONG-TERM IMPACT OF SUPERINFECTION BY HEPATITIS G VIRUS IN HEPATITIS C VIRUS-POSITIVE RENAL TRANSPLANT PATIENTS. Transplantation 67:4, 556-560
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   L. Sheng, A. Soumillion, N. Beckers, C.-G. Wu, C. Verslype, F. Nevens, J. Pirenne, R. Aerts, H. Kosala, J. Fevery, S. H. Yap. (1998) Hepatitis G virus infection in acute fulminant hepatitis: prevalence of HGV infection and sequence analysis of a specific viral strain. Journal of Viral Hepatitis 5:5, 301-306
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   José L. Rodríguez Agulló, Avelina Suárez, José M. Ladero, Gustavo López-Alonso, Juan J. Picazo, Manuel Díaz-Rubio. (1998) Hepatitis G virus infection in Spanish patients with hepatocellular carcinoma. Liver 18:4, 255-258
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   P Karayiannis. (1998) Natural history and molecular biology of hepatitis G virus/GB virus C. Clinical and Diagnostic Virology 10:2-3, 103-111
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   Alison Casteling, Ernie Song, John Sim, Duane Blaauw, Anthon Heyns, Rose Schweizer, Larry Margolius, Eben Kuun, Steve Field, Barry Schoub, Eftyhia Vardas. (1998) GB virus C prevalence in blood donors and high risk groups for parenterally transmitted agents from Gauteng, South Africa†. Journal of Medical Virology 55:2, 103-108
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   Murthy, A. Scott Muerhoff, Suresh M. Desai, Svetlozar N. Natov, Beth A. Bouthot, Robin Ruthazer, Christopher H. Schmid, Andrew S. Levey, Isa K. Mushahwar, Brian J.G. Pereira. (1998) Predictors of GBV-C infection among patients referred for renal transplantation. Kidney International 53:6, 1769-1774
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    Sheng Lou, Xiaoxing Qiu, Gary Tegtmeier, Sandra Leitza, John Brackett, Kristen Cousineau, Amit Varma, Heidi Seballos, Samar Kundu, Steve Kuemmerlea, J.C. Hunt. (1997) Immunoassays to study prevalence of antibody against GB virus C in blood donors. Journal of Virological Methods 68:1, 45-55
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    Klaus Stark, Christian G. Meyer, Michael Tacke, Anke Schwarz, Claudia Braun, Daniela Huzly, Alfred M. Engel, J??rgen May, Ulrich Bienzle. (1997) HEPATITIS G VIRUS RNA AND HEPATITIS G VIRUS ANTIBODIES IN RENAL TRANSPLANT RECIPIENTS. Transplantation 64:4, 608-612
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    P. Karayiannis, H.C. Thomas. (1997) Current Status of Hepatitis G Virus (GBV-C) in Transfusion: Is It Relevant?. Vox Sanguinis 73:2, 63-69
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    Chwan-Heng Wanga, B. Flehmig, G. Jahn, Shu-Yuan Tschen. (1997) Hepatitis E Virus in Haemodialysis. Vox Sanguinis 73:1, 54-55
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