Cryptogenic liver disease in the United States: further evidence for non-A, non-B, and non-C hepatitis.

UNLABELLED

Since the advent of anti-hepatitis C virus (HCV)-testing, the current worldwide prevalence of cryptogenic cirrhosis is essentially unknown.

OBJECTIVES

1. determine if serum HCV RNA testing by the polymerase chain reaction (PCR) enhances the diagnostic yield for HCV in patients with anti-HCV-negative cryptogenic liver disease and 2) further define the epidemiology of patients with indeterminate causes of chronic hepatitis and cirrhosis.

METHODS

We reviewed the records of 567 patients with chronic liver disease who were evaluated over a 3-yr period. A definite etiology for liver disease was established in all but 28 patients (4.9%). Histology was available in 20 patients.

RESULTS

Twenty-one of the 28 patients were female (mean age, 52 yr). Thirteen patients (46%) had a history of previous blood transfusion, and one patient was a health care worker. Histology revealed CAH/cirrhosis in 17 patients, CPH in one patient, and no diagnosis in two patients. Five additional patients had clinically advanced cirrhosis. None of the 28 patients with cryptogenic chronic liver disease was HCV RNA positive by PCR.

CONCLUSIONS

1. Approximately 5% of patients with chronic hepatitis/cirrhosis remain cryptogenic despite the addition of HCV RNA testing. 2) PCR does not improve the diagnostic yield in this population. 3) Nearly half of the patients with presumed cryptogenic cirrhosis have been transfused, supporting the hypothesis of a non-A, non-B, and non-C hepatitis virus. 4) Screening donor blood for serum ALT may still be necessary to further reduce posttransfusion hepatitis.