Hepatology 1993 Dec;18(6):1338-1343
The pathology of Hepatitis C as a function of mode of transmission: blood
transfusion vs. intravenous drug use.
Gordon SC, Elloway RS, Long JC, Dmuchowski CF
Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073
We reviewed the clinical records of 140 consecutively evaluated patients with
chronic Hepatitis C infection. One hundred twenty-four patients (89%) contracted
infection through blood transfusion or intravenous drug use. The liver biopsy
specimens of 83 patients (43 blood transfusion cases and 40 intravenous drug
abuse cases) were examined without knowledge of the mode of disease transmission.
The mean histological activity index score was significantly higher in the blood
transfusion group (10.2 +/- 4.2) than in the intravenous drug use group (6.9
+/- 4.5) (p = 0.001). The transfusion group had more periportal bridging necrosis
(p = 0.0015) and fibrosis (p = 0.0016) than did the intravenous drug use group,
whereas significant differences between lobular degeneration and portal inflammation
were not achieved across the two groups. The distribution of final biopsy interpretations
also differed significantly between the two groups (p < 0.001), with chronic
active hepatitis more frequent in the transfusion group. Moreover, lymphoid
aggregates and bile duct damage were more common in patients with chronic hepatitis
due to blood transfusion. Multivariate analysis showed that the mode of viral
transmission was the most powerful predictor of histological activity index
score when tested against patient gender, duration of disease or age at biopsy.
One year after completion of this study, 9 of 70 transfused patients and 1 of
54 intravenous drug users had died of liver disease or are awaiting liver transplantation
at this writing (p = 0.03). We conclude that transfusion-acquired Hepatitis
C is associated with more aggressive histological inflammatory activity than
hepatitis resulting from intravenous drug use.
PMID: 8244258, UI: 94063767
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