Transfusion-related hepatitis G virus infections in heart transplant recipients.

Abstract

Investigations of immunocompetent patients and blood donors showed that infections with the recently discovered hepatitis G virus (HGV) are frequent, often asymptomatic, and transmissible by transfusions(1, 2). However, the impact of HGV infections on immunosuppressed recipients has not yet been studied in detail. We assayed blood samples from 243 adult heart transplant (HTx) recipients(transplantations between January 1993 and March 1996) under immunosuppressive maintenance with cyclosporine and/or azathioprine and/or prednisone, with two HGV-specific nested reverse transcription polymerase chain reaction (PCR) assays (specific for the 5′-terminal noncoding region and for the NS 5 region,1 a hepatitis C virus (HCV)-specific reverse transcription PCR (3), and a cytomegalovirus(CMV)-specific PCR (4). Blood samples from 224 unselected blood donors were also assayed by PCR. In 142 HTx recipients, serum transaminases, bilirubin, hyaluronic acid (as a marker for liver function), and neopterin were determined. Overall, 58/243 (24%) HTx recipients were HGV RNA positive, among them 34/60 (57%) patients who had had a mechanical circulatory assist device. Three of 224 (1.3%) blood donors were HGV RNA positive. HCV RNA was not detected in any HTx recipient or blood donor. CMV DNA was not detected in any of the HGV RNA-positive HTx recipients. Serum transaminases, bilirubin, hyaluronic acid, and neopterin levels did not differ significantly between HGV RNA-positive and HGV RNA-negative patients (mean values of viremic vs. nonviremic HTx recipients): aspartate aminotransferase (U/L) 20±8 vs. 16±5, alanine aminotransferase(U/L) 11±8 vs. 10±4, γ-glutamyl transpeptidase (U/L) 39±40 vs. 33±33, bilirubin (mg/dl) 0.7±0.3 vs. 0.9±0.3, hyaluronic acid (μg/dl) 60.7 (20-178) vs. 54 (20-108), neopterin (nmol/L) 17.3±16 vs. 16.7±10.5. HGV infections were not correlated with the duration of immunosuppression, but closely with transfusion frequency and the use of mechanical circulatory assist devices (which initially require frequent transfusions)(Table 1). No double infections with HCV or CMV and HGV were observed in our cohort of recent HTx recipients (4), although our previous studies demonstrated a 17% prevalence of CMV DNA in the peripheral blood of HTx recipients. This finding is due to the fact that all blood donations were screened for anti-HCV and anti-CMV antibodies, and recently also for HCV RNA and CMV DNA. Our results demonstrate that HGV infections are indeed transfusion related, not directly related to the use of mechanical circulatory assist devices, and not a complication of immunosuppression, as it is the case with CMV infections(4). Dietmar Wolff2,3 Michael M. Körner4 Carsten Wolff2 Reiner Körfer4 Knut Kleesiek2 Institut für Laboratoriums- und Transfusionsmedizin; Klinik für Thorax- und Kardiovaskularchirurgie; Herz- und Diabeteszentrum Nordrhein-Westfalen; Universitätsklinik der Ruhr-Universität Bochum; Bad Oeynhausen, Germany