Long-term mortality and morbidity of transfusion-associated non-A, non-B, and type C hepatitis: A National Heart, Lung, and Blood Institute collaborative study.
Persons with non-A, non-B hepatitis (cases) identified in 5 transfusion studies in the early 1970s have been followed ever since and compared for outcome with matched, transfused, non-hepatitis controls from the same studies. Previously, we reported no difference in all-cause mortality but slightly increased liver-related mortality between these cohorts after 18 years follow-up. We now present mortality and morbidity data after approximately 25 years of follow-up, restricted to the 3 studies with archived original sera. All-cause mortality was 67% among 222 hepatitis C-related cases and 65% among 377 controls (P = NS). Liver-related mortality was 4.1% and 1.3%, respectively (P =.05). Of 129 living persons with previously diagnosed transfusion-associated hepatitis (TAH), 90 (70%) had proven TAH-C, and 39 (30%), non-A-G hepatitis. Follow-up of the 90 TAH-C cases revealed viremia with chronic hepatitis in 38%, viremia without chronic hepatitis in 39%, anti-HCV without viremia in 17%, and no residual HCV markers in 7%. Thirty-five percent of 20 TAH-C patients biopsied for biochemically defined chronic hepatitis displayed cirrhosis, representing 17% of all those originally HCV-infected. Clinically evident liver disease was observed in 86% with cirrhosis but in only 23% with chronic hepatitis alone. Thirty percent of non-A, non-B hepatitis cases were unrelated to hepatitis viruses A,B,C, and G, suggesting another unidentified agent. In conclusion, all-cause mortality approximately 25 years after acute TAH-C is high but is no different between cases and controls. Liver-related mortality attributable to chronic hepatitis C, though low (<3%), is significantly higher among the cases. Among living patients originally HCV-infected, 23% have spontaneously lost HCV RNA.
Seeff
L B
LB
The Veterans Affairs Medical Centers, Washington, DC, USA. seeffl@extra.niddk.nih.gov
Hollinger
F B
FB
Alter
H J
HJ
Wright
E C
EC
Cain
C M
CM
Buskell
Z J
ZJ
Ishak
K G
KG
Iber
F L
FL
Toro
D
D
Samanta
A
A
Koretz
R L
RL
Perrillo
R P
RP
Goodman
Z D
ZD
Knodell
R G
RG
Gitnick
G
G
Morgan
T R
TR
Schiff
E R
ER
Lasky
S
S
Stevens
C
C
Vlahcevic
R Z
RZ
Weinshel
E
E
Tanwandee
T
T
Lin
H J
HJ
Barbosa
L
L
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000401:mortality*; D018937:Hepatitis C Antibodies / Q000032:analysis; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000821:virology; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D065227:Transfusion Reaction; D014766:Viremia / Q000453:epidemiology
D018937:Hepatitis C Antibodies