title: Fulminant non--A-G viral hepatitis leading to liver transplantation.
abstract: BACKGROUND
  All hepatotropic viruses are known to cause fulminant hepatic failure (FHF). However, in 30% to 40% of patients with FHF, the precise cause remains unknown. We aimed to better define this subgroup.
  
  
  METHODS
  We evaluated the clinical course and outcome of 7 patients admitted during a 22-month period with fulminant viral hepatitis leading to liver transplantation; none had serologic or molecular evidence of hepatitis A, B, C, D, E, or G viral infection, thus the term non-A-G viral hepatitis. All known etiologies of FHF were excluded.
  
  
  RESULTS
  All patients had prodromal symptoms suggestive of viral causes. Mean age was 30 years. The interval between onset of jaundice and appearance of encephalopathy was 23 days (range, 4-50 days). Five patients had grade III/IV encephalopathy. Serum alanine aminotransferase levels showed a single peak of activity. The duration between first symptoms and liver transplantation was 28 days (range, 12-71 days). Results of histological study of the explanted liver showed submassive (4 patients) or massive (3 patients) hepatocyte necrosis. In all patients, results of polymerase chain reaction analysis did not detect hepatitis B virus DNA, hepatitis C virus RNA, or hepatitis G virus RNA in the explanted liver. After transplantation, 2 patients showed (6 months later) increased liver enzyme levels of undetermined cause, and results of a liver biopsy showed mild lobular hepatitis; 1 patient had lymphoproliferative disorder (Epstein-Barr virus-originated); and 1 patient, aplastic anemia, which is known to be associated with seronegative viral hepatitis. The latter patient died, whereas the other 6 patients are alive (survival rate, 86%).
  
  
  CONCLUSIONS
  Our patients with non-A-G viral hepatitis had a severe acute onset with progressive FHF requiring liver transplantation. There is some suggestion of recurrent viral disease after transplantation implicating other unknown viruses in the etiology.
authors.affiliation: Liver Institute and Department of Medicine D, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Ben-Ari
authors.forename: D
authors.initials: D
authors.lastname: Samuel
authors.forename: R
authors.initials: R
authors.lastname: Zemel
authors.forename: Y
authors.initials: Y
authors.lastname: Baruch
authors.forename: M
authors.initials: M
authors.lastname: Gigou
authors.forename: E
authors.initials: E
authors.lastname: Sikuler
authors.forename: R
authors.initials: R
authors.lastname: Tur-Kaspa
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018067:Flaviviridae / Q000235:genetics / Q000276:immunology; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000821:virology; D006507:Hepatovirus / Q000235:genetics / Q000276:immunology; D006801:Humans; D017093:Liver Failure / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral