Figure 1048

Hepatitis G virus (HGV) in renal transplantation: prevalence of infection and associated findings. Hepatitis G virus is an RNA virus of the flaviviridae family. Hepatitis G virus was isolated independently by two different groups of investigators and called hepatitis GB viruses by Simmons and colleagues, and hepatitis G virus by Lenin and colleagues. It now appears that GB virus-A and GB virus-B are tamarin viruses and GBV-C is a human virus with sequence homology of more than 95% with the hepatitis GV sequence. The virus has been shown to be transmitted by transfusions, including plasma products, by frequent parenteral exposure, including intravenous (IV) drug abuse, by sexual exposure, and by mother to child transmission. In the United States, the prevalence of hepatitis G virus is 1.7% among healthy volunteer blood donors, 8.3% among cadaveric organ donors, and 33% among IV drug abusers. Among chronic hemodialysis patients, the prevalence of hepatitis G virus RNA has been variable, ranging from 3.1% in Japan to 55% in Indonesia and some areas in France. Likewise, the reported incidence of co-infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is extremely variable.

Hepatitis G virus RNA is detected by reverse transcriptase poly-merase chain reaction (PCR). The development of reliable serologic assays for hepatitis G has been difficult due to the lack of linear epitopes expressed by hepatitis G virus. The risk for pretransplant hepatitis G infection is associated with increasing numbers of blood transfusions and with longer duration of dialysis. Post-transplantation, most patients with hepatitis G virus remain viremic; however, patients have been shown to clear the virus post-transplant. At this time, hepatitis G virus does not appear to invoke a poor outcome after transplantation, either in the form of severe liver disease or increased mortality; however, the long-term studies needed to provide a firm conclusion about this have not been performed. The question of transmission of hepatitis G virus via transplantation is still under investigation. NA—not available; NEOB— New England Organ Bank. (Data from Dussol and coworkers [26], Murthy and coworkers [27], and Fabrizi and coworkers [28].)

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