Jun 1, 2013 - The genotype of hepatitis C virus does not affect severity of liver ... variable prevalence of liver failure caused by veno-occlusive disease.
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1995 85: 2640
The genotype of hepatitis C virus does not affect severity of liver disease after bone marrow transplantation [letter; comment] A Locasciulli, P Pontisso, A Alberti, A Bacigalupo, P Ljungman and N Frickhofen
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From bloodjournal.hematologylibrary.org by guest on June 1, 2013. For personal use only.
2640
CORRESPONDENCE
The Genotype of Hepatitis C Virus Does Not Affect Severity of Liver Disease After Bone Marrow Transplantation To the Editor:
Approximately 5% to 15% of patients undergoing bone marrow transplantation (BMT) develop fatal hepatic failure. Recently Frickhofen et al' have suggested that preexisting hepatitis C virus (HCV) infection may predispose to the development of liver failure after BMT whereas other investigators did not find such a correlation?' Because distinct HCV genotypes exist and have been shown to associate with different degrees of liver damage, with HCV Ib causing more severe disease, particularly after liver transplantation, it may be speculated that HCV genotypes could account also for the variable prevalence of liver failure caused by veno-occlusive disease (VOD) in BMT patients infected with HCV. Therefore, wehave investigated HCV genotypes in 35 patients with HCV infection who underwent allogeneic BMT in three European centers where posttransplant mortality in HCV-infected patients has been reported as high (Ulm, Germany), intermediate (Genova, Italy), and low (Huddinge, Sweden). In all patients, HCV genotypes, classified according to Simmonds et a1: were identified by hybridization of 5'UTR amplified products with type-specific oligonucleotides probes, as described by Tisminetzky et aL5 The distribution ofHCV genotypes in the three BMT units and its relation to different liver disease after BMT are summarized in Table 1. Liver failure was caused by VOD in 7/19 patients (37%), hepatitis (fulminant or subacute) in 8/19 (42%). and hepatic graft-versus-host disease in 4/19 (21%). Thus, in our series there was no clear correlation between the genotype of infecting HCV and the severity of post-BMT liver disease, indicating that the determinants of hepatic complications were independent of the degree of virus cytopathogenicity. Anna Locasciulli Clinica Pediatrica Universita di Milano Divisione di Ematologia Pediatrica Ospedale S. Gerard0 Monza, Italy Patrizia Pontisso Alfred0 Alberti Clinica Medica 2" Universita di Padova Padova. Italy
Andrea Bacigalupo Ematologia 2" Ospedale S. Martino Genova, Italy
Per Ljungman Department of Medicine Huddinge University Hospital Karolinska Institute Huddinge, Sweden Norbert Frickhofen Department of Medicine Ill University of Ulm Ulm, Germany
REFERENCES 1. Frickhofen N, Wiesneth M, Jainta C, Hertenstein B, Heymer B, Bianchi L, Dienes HP, Koemer K, Bunjes D, Arnold R, Kubanek K, Heimpel H: Hepatitis C virus infection is a risk factor for liver failure from veno-occlusive disease after bone marrow transplantation. Blood 83:1998, 1994 2. Locasciulli A, Bacigalupo A, VanLint MT. Tagger A, Uderzo C, Portmann B, Shulman HM, Alberti A: Hepatitis C virus infection in patients undergoing allogeneic bone marrow transplantation. Transplantation 52:315, 1991 3. Ljungman P, Hagglund H, Lonnqvist B, Sonnerborg A, Ringden 0: Hepatitis C virusas a risk factor for the development of veno-occlusive disease of the liver. Blood 84: 1349, 1994 (letter) 4. Simmonds P, Holmes EC, Cha TA, Chan SW, McOmish F, Irvine B, Beall E, Yap PL, Kolberg J, Urdea MS: Classification of hepatitis C virus into six major genotypes and a series of subtypes by phylogenetic analysis of the NS-5 region. J Gen Virol 74:2391. I993 5. Tisminetzky SG, Gerotto M, Pontisso P, Alberti A: Genotypes of hepatitis C virus in Italian patients with chronic hepatitis C. Int J Hepatol Commun 2: 105, 1994
Table 1. HCV Genotypes in 35 HCV-Infected Patient8 Undergoing BMT and Relation to Posttran8plant Liver Disease No. Positive Cases (96) ALL Huddinge
HCV genotype HCV 1 HCV 1 + HCV 2 HCV 2 HCV 2 + HCV 3 HCV 3
(n = 351
Genova (n = 161
17 (48.6) 1 (2.8) 13 (37) 1 (2.8) 3 (8.6)
6 (43) 1 (7) 7 (50) 0 0
In = 131
BMT
After Disease Liver Ulm (n = 8)
6 (46) 0
5 (62.5) 0
5 (38.5) 1 (7.7) 1 (7.7)
1 (12.5) 0 2 (25)
AH
None
3 0 1 0 0
LF
0 0 3 1 0
CH
4
0
10 1 6 0
1
2
0 3
Abbreviations: AH, abnormal transaminase value for less than 6 months; CH, abnormal transaminase value for more than 6 months; LF. died of liver failure.
