title: 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.
abstract: 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.
authors.affiliation: The Veterans Affairs Medical Centers, Washington, DC, USA. seeffl@extra.niddk.nih.gov
authors.forename: L B
authors.initials: LB
authors.lastname: Seeff
authors.forename: F B
authors.initials: FB
authors.lastname: Hollinger
authors.forename: H J
authors.initials: HJ
authors.lastname: Alter
authors.forename: E C
authors.initials: EC
authors.lastname: Wright
authors.forename: C M
authors.initials: CM
authors.lastname: Cain
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Buskell
authors.forename: K G
authors.initials: KG
authors.lastname: Ishak
authors.forename: F L
authors.initials: FL
authors.lastname: Iber
authors.forename: D
authors.initials: D
authors.lastname: Toro
authors.forename: A
authors.initials: A
authors.lastname: Samanta
authors.forename: R L
authors.initials: RL
authors.lastname: Koretz
authors.forename: R P
authors.initials: RP
authors.lastname: Perrillo
authors.forename: Z D
authors.initials: ZD
authors.lastname: Goodman
authors.forename: R G
authors.initials: RG
authors.lastname: Knodell
authors.forename: G
authors.initials: G
authors.lastname: Gitnick
authors.forename: T R
authors.initials: TR
authors.lastname: Morgan
authors.forename: E R
authors.initials: ER
authors.lastname: Schiff
authors.forename: S
authors.initials: S
authors.lastname: Lasky
authors.forename: C
authors.initials: C
authors.lastname: Stevens
authors.forename: R Z
authors.initials: RZ
authors.lastname: Vlahcevic
authors.forename: E
authors.initials: E
authors.lastname: Weinshel
authors.forename: T
authors.initials: T
authors.lastname: Tanwandee
authors.forename: H J
authors.initials: HJ
authors.lastname: Lin
authors.forename: L
authors.initials: L
authors.lastname: Barbosa
mesh_terms: 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
chemical_list: D018937:Hepatitis C Antibodies