Hepatitis after liver transplantation: The role of the known and unknown viruses

This study was designed to determine the cause of posttransplantation hepat itis in patients undergoing transplantation for liver disease of nonviral c ause; the Pole of acquired hepatitis B virus (HBV), hepatitis C Virus (HCV) , and hepatitis G virus (HGV) in posttransplantation hepatitis; and the cou rse of posttransplantation hepatitis of unknown cause, Two hundred forty-th ree patients underwent transplantation for nonviral liver diseases (mean ag e, 48 years; 103 men, 140 women). Serological and virological assays for HB V and HCV were performed pretransplantation to exclude preexisting infectio n and posttransplantation to investigate the cause of posttransplantation h epatitis. Histology was graded on all available biopsy specimens; posttrans plantation hepatitis was assessable in 150 patients. Posttransplantation he patitis was present in 29% (44 of 150) of the patients after a median follo w-up of 47 months (range, 1 to 101 months). Actuarial survival was signific antly lower in patients with posttransplantation hepatitis compared with pa tients without (71% v 89% at 5-year follow-up; P = .03), HCV and HBV were i dentified posttransplantation in 14% and 9% of patients with hepatitis, res pectively. After the exclusion of HCV and HBV infection, 22% (33 of 150) of the patients had posttransplantation hepatitis of unknown cause, HGV was p resent in 58% of these patients, but HGV was equally prevalent in patients without posttransplantation hepatitis. When patients with HBV and HCV were excluded, there was no difference in survival between patients with posttra nsplantation hepatitis compared with patients without (P = .08, log-rank te st). Posttransplantation hepatitis was present in approximately 30% of the patients undergoing transplantation for nonviral diseases, with a median fo llow-up of 47 months. Known hepatitis Viruses (HBV, HCV) were present in on e fourth of the patients with posttransplantation hepatitis; 22% (33 of 150 ) of the patients had hepatitis of unknown cause, suggesting that other, as yet undiscovered, hepatitis Viruses may exist. (C) 1998 by the American As sociation for the Study of Liver Diseases.