ABSTRACT Dengue, an infection characterized by recurrent epidemic spanning 3 to 5 years, stands out as a one of the most prominent problem due to its escalating case number and geographic extension. Despite its vast distribution, the disease occurs most intensely in the Americas and Southeast Asia. Within this scenario, it is imperative to carefully assess the potential repercussions of this epidemic on transplant activity. Although literature on this matter remains sparse, a review of probable and confirmed cases of dengue transmission through infected donors was carried out, addressing clinical characteristics and outcomes in recipients of such organs. Considering the strategies adopted in other countries that have already experienced dengue epidemics with the transmission of the virus through organ transplantation, the Comissão de Infecção em Transplante (COINT) da Associação Brasileira de Transplante (ABTO) delineates a protocol for screening potential donors and transplant candidates. This protocol involves the combined use of NS1/IgM on blood, alongise stringent criteria for evaluating donor and recipient suitability. Dengue years extension distribution Asia scenario activity sparse organs transplantation COINT (COINT ABTO (ABTO candidates NS1IgM NSIgM NS1 IgM NS blood suitability

RESUMO A dengue, infecção caracterizada por ciclos epidêmicos que se repetem a cada 3 a 5 anos, figura como um dos problemas de maior destaque, tendo em vista sua progressiva expansão em número de casos e extensão geográfica. Em que pese sua vasta distribuição geográfica, é nas Américas e Sudeste Asiático que a doença incide de forma mais intensa. No contexto de surtos e epidemias, as infecções transmitidas pelos doadores podem representar um grande desafio devido à falta de dados, na literatura, de uma política clara para triagem dos doadores e dos possíveis desfechos indesejáveis. Casos de transmissão provável e confirmada têm sido relatados em receptores de diferentes órgãos. Embora o total de casos descritos seja pequeno, é importante considerar a possibilidade de subnotificação e o aumento substancial do risco desse evento, especialmente nos períodos em que a transmissão da dengue atinge níveis epidêmicos na população. Com base na escassa literatura, porém baseada em estratégias adotadas em outros países que já experimentaram epidemias de dengue com transmissão do vírus por meio de transplante de órgãos, a Comissão de Infecção em Transplante (COINT) da Associação Brasileira de Transplante (ABTO) sugere triagem de doadores e candidatos a transplante com o uso combinado de NS1/IgM no sangue e critérios para o aceite do doador e do candidato. anos destaque geográfica intensa dados literatura indesejáveis órgãos pequeno evento população COINT (COINT ABTO (ABTO NS1IgM NSIgM NS1 IgM NS candidato

ABSTRACT COVID-19 is commonly associated with high serum levels of pro-inflammatory cytokines, and the post-infection status can disturb self-tolerance and trigger autoimmune responses. We are reporting a 45-year-old male who was admitted with fatigue, jaundice, elevated liver enzymes (with cholestatic pattern), and acute kidney injury two weeks after recovering from a mild SARS-CoV-2 infection. Serologies for viral hepatitis and anti-mitochondrial antibody were negative, while anti-nuclear and anti-smooth muscle antibodies were positive. There were no signs of chronic liver disease, and a magnetic resonance cholangiography showed no dilatation of biliary ducts. Histologic evaluation of the liver evidenced numerous foci of lobular necrosis without ductopenia or portal biliary reaction. Considering the autoantibody profile and histologic changes, the medical team started oral prednisone, but there was a suboptimal biochemical response in the outpatient follow-up. Two months later, a second liver biopsy was performed and revealed non-suppurative destructive chronic cholangitis, extensive areas of confluent necrosis with hepatocytes regenerating into pseudorosettes, and numerous plasma cells. According to the Paris Criteria, the patient was then diagnosed with an autoimmune hepatitis-primary biliary cholangitis overlap syndrome (AIH-PBC-OS). After adding azathioprine and ursodeoxycholic acid to the treatment, there was a satisfactory response. This is the second worldwide report of an AIH-PBC-OS triggered by COVID-19, but the first case with a negative anti-mitochondrial antibody. In this setting, histologic evaluation of the liver by an experienced pathologist is a hallmark of achieving the diagnosis and correctly treat the patient. COVID19 COVID 19 COVID-1 proinflammatory pro inflammatory cytokines postinfection post infection selftolerance self tolerance responses 45yearold yearold 45 year old fatigue jaundice pattern, pattern , pattern) SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- antimitochondrial anti mitochondrial antinuclear nuclear antismooth smooth positive disease ducts reaction changes prednisone followup. followup follow up. up follow-up later nonsuppurative non suppurative pseudorosettes cells Criteria hepatitisprimary primary AIHPBCOS. AIHPBCOS AIH PBC OS . (AIH-PBC-OS) treatment COVID19, 19, setting COVID1 1 COVID- 4 SARS-CoV (AIH-PBC-OS

Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

RESUMO A pandemia da Covid-19 trouxe desafios ao sistema de saúde em diversas esferas: diagnóstico, tratamento e medidas para evitar a disseminação da doença. Com a maior disponibilização e variedades de testes diagnósticos, torna-se fundamental sua adequada interpretação. Este posicionamento pretende orientar unidades de diálise em relação ao uso de critérios clínicos e testes diagnósticos para a tomada de decisão referente à descontinuação do isolamento de pacientes com suspeita ou confirmação de Covid-19, assim como para o retorno às atividades laborais de colaboradores com suspeita ou confirmação de Covid-19.

ABSTRACT The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.

RESUMO Contexto - Na doença hepática crônica os níveis plasmáticos de oligoelementos normalmente apresentam-se baixos, mas a causa específica e implicações funcionais desta anormalidade ainda não estão bem esclarecidas. Estes elementos podem estar diminuídos em consequência da função hepática alterada em pacientes com cirrose e/ou desnutrição. Objetivo - Avaliar o estado nutricional e o perfil de oligoelementos plasmáticos dos pacientes com cirrose hepática em lista para transplante e correlacionar com a gravidade da doença. Métodos - Trata-se de um estudo transversal, no qual foram avaliados 31 pacientes do sexo masculino com diagnóstico de cirrose hepática compensada em lista de espera para transplante de fígado. O estado nutricional foi avaliado objetivamente por medidas antropométricas através do escore de Mendenhall e classificado segundo Blackburn, subjetivamente por um questionário sistematizado por Detsky e a gravidade da doença pelo escore MELD e CTP. Os oligoelementos plasmáticos (Zn, Se, Cu, Ca, Fe, Mg e Mn) foram analisados pelo método de espectrometria de massas com fonte de plasma indutivamente acoplado (ICP-MS). Para análise estatística foi utilizado o Teste de Mann-Whitney. Resultados - De acordo com a avaliação nutricional 19 (61,3%) estavam com desnutrição e 12 (38,7%) com sobrepeso. Em relação à gravidade da doença 12 (39%) foram classificados como Child A, 17 (55%), Child B e 2 (6%) Child C, sendo 46,9% dos pacientes com o escore MELD >17. Na análise dos oligoelementos 31 (100%) apresentaram níveis de Mn acima dos valores de referência, 23 (74,2%) níveis baixos de Cu, 29 (93,5%) com deficiência de Se, e 31 (100%) níveis baixos de Ca e Mg. Em relação à gravidade da doença não houve diferença estatística entre os oligoelementos estudados, já em relação ao estado nutricional o grupo desnutrido apresentou níveis maiores de Mn (P=0,01) e Fe (P=0,01) e níveis diminuídos de Zn (P=0,03) quando comparado ao grupo sobrepeso. Conclusão - Os resultados mostraram que os oligoelementos estão alterados na doença hepática crônica, sem associação significativa com a gravidade da doença, mas sim com o estado nutricional. A desnutrição está presente nos pacientes estudados, porém um novo cenário com aumento na prevalência de sobrepeso foi verificado independente do grau de descompensação hepática.

ABSTRACT Background - In chronic liver disease, trace element levels in plasma are usually low. However, the specific cause and functional implications of this abnormality are yet not well understood. These element levels may decrease as a result of abnormal liver function in patients with cirrhosis and/or malnutrition. Objective - To evaluate the nutritional status and the profile of trace elements in plasma of patients with cirrhosis on a liver transplant list and to correlate them with disease severity. Methods - This cross-sectional study evaluated 31 male patients diagnosed with compensated liver cirrhosis on a waiting list for liver transplant. Nutritional status was objectively evaluated through anthropometry using Mendenhall score and Blackburn classification, subjectively through the Detsky questionnaire and severity of the disease by MELD and CTP score. Trace elements (Zn, Se, Cu, Ca, Fe, Mg and Mn) in plasma were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was performed using Mann-Whitney test. Results - According to the nutritional assessment 19 (61.3%) were malnourished and 12 (38.7%) were overweight. Regarding disease severity 12 (39%) were classified as Child A, 17 (55%), Child B and 2 (6%) Child C, with 46.9% of patients with MELD score >17. The trace element analysis indicated that 31 (100%) had Mn levels above the reference range, 23 (74.2%) low levels of Cu, 29 (93.5%) with deficiency of Se, and 31 (100%) low levels of Ca and Mg. Disease severity did not show statistical difference between the studied trace elements, in contrast to the nutritional status, in which the malnourished group showed higher levels of Mn (P=0.01) and Fe (P=0.01) and low levels of Zn (P=0.03) when compared to the overweight group. Conclusion - The results showed that the trace elements in plasma are altered in chronic liver disease; without significant correlation to disease severity, but correlated to nutritional status. Malnutrition is present in the patients studied, nonetheless a new scenario with an increase in the prevalence of overweight was verified regardless of the degree of hepatic decompensation.

Herpesvirus reactivation is common after liver transplantation.OBJECTIVE:Analyze the presence of cytomegalovirus (HCMV) and human herpesvirus-6 (HHV-6) DNA in liver donor biopsies, seeking to better understand issues involving human donor leukocyte antigens (HLA)-A, B and DR, as well as correlations with acute cellular rejection.METHODS:Fifty-nine liver transplantation patients were investigated for the presence of HCMV and HHV-6 DNA in liver donor biopsies, using the Nested-PCR technique. The clinical donor information and HLA matches were obtained from the São Paulo State Transplant System. The recipients' records regarding acute cellular rejection were studied.RESULTS:Seven (11.8%) biopsies were positive for HCMV DNA and 29 (49%) were positive for HHV-6 DNA. In 14 donors with HLA-DR 15 nine had HHV-6 DNA positive liver biopsy with a tendency for significant association (p=0.09), 22 recipients developed acute cellular rejection and 9/22 were positive for HLA-DR 15 (p=0.03; χ2=4.51), which was statistically significant in univariate analysis and showed a tendency after multivariate analysis (p=0.08).CONCLUSION:HHV-6 DNA was prevalent in liver donors studied as well as HLA-DR 15. These findings suggest that patients with HLA-DR 15 in liver donor biopsies develop more rejection after liver transplantation.

OBJECTIVE: The aim of this study was to simultaneously monitoring cytomegalovirus and human herpesvirus 6 active infections using nested-polymerase chain reaction and, together with clinical findings, follow the clinical status of patients undergoing liver transplant. INTRODUCTION: The human β-herpesviruses, including cytomegalovirus and human herpesvirus 6, are ubiquitous among human populations. Active infections of human herpesvirus 6 and cytomegalovirus are common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy. Both viruses affect the success of the transplant procedure. METHODS: Thirty patients submitted to liver transplant at the Liver Transplant Unit, at the Gastro Center, State University of Campinas, SP, Brazil, were studied prospectively from six months to one year, nested-polymerase chain reaction for cytomegalovirus and human herpesvirus 6 DNA detections. Two or more consecutive positive nested-polymerase chain reaction were considered indicative of active infection. RESULTS: Active infection by cytomegalovirus was detected in 13/30 (43.3%) patients, median time to first cytomegalovirus detection was 29 days after transplantation (range: 0-99 days). Active infection by human herpesvirus 6 was detected in 12/30 (40%) patients, median time to first human herpesvirus 6 detection was 23.5 days after transplantation (range: 0-273 days). The time-related appearance of each virus was not statistically different (p = 0.49). Rejection of the transplanted liver was observed in 16.7% (5/30) of the patients. The present analysis showed that human herpesvirus 6 and/or cytomegalovirus active infections were frequent in liver transplant recipients at our center. CONCLUSIONS: Few patients remain free of betaherpesviruses after liver transplantation. Most patients presenting active infection with more than one virus were infected sequentially and not concurrently. Nested-polymerase chain reaction can be considered of limited value for clinically monitoring cytomegalovirus and human herpesvirus 6.

RACIONAL: Utiliza-se o escore MELD (Model End-Stage Liver Disease) para o prognóstico da mortalidade em lista de espera para transplante de fígado e, em alguns estudos, para predição da sobrevida pós-operatória a longo prazo. OBJETIVO: Verificar a aplicação do escore MELD como predição da sobrevida após o transplante. MÉTODOS: Por intermédio de dados coletados prospectivamente efetuou-se um estudo de coorte longitudinal retrospectivo em 232 pacientes. Excluíram-se os retransplantes, insuficiência hepática aguda, crianças e enxertos duplos ou reduzidos. Avaliaram-se os dados dos doadores: idade, sexo, peso, creatinina, bilirrubina, sódio, aspartato aminotransferase, antecedentes pessoais, causa da morte, presença de esteatose, número de critérios expandidos do doador e índice de risco do doador. Em relação aos receptores, analisaram-se as variáveis: sexo, idade, peso, doença hepática, pontos de Child-Turcotte-Pugh, escore MELD, depuração de creatinina, sódio, tempos de isquemia e de hospitalização, quantidade de hemoderivados transfundidos, presença e grau de disfunção do enxerto. A análise estatística foi efetuada usando-se a análise de regressão univariada e/ou múltipla, estatística 'c', teste exato de Fisher, método de Kaplan-Meier (teste log-rank) para sobrevida, e análise de regressão de Cox para risco de óbito ajustado para as condições clínicas. RESULTADOS: O ponto de corte MELD para sobrevida foi 20 e de Child-Turcotte-Pugh foi 11,5. Para escore MELD maior ou igual a 20, os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e o sódio do doador. Para os hiponatrêmicos os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e sódio do doador. A sobrevida estimada para pacientes com escore MELD >25 foi menor ao final de 12 meses (68,86% vs 39,13%). A sobrevida estimada para os pacientes sem hiponatremia foi maior (65,16% vs 44,44%). A sobrevida aos 5 e 10 anos também seguiu o mesmo padrão. O uso de doadores limítrofes não alterou a sobrevida, mas quando se utilizou o índice de risco do doador observou-se que a sobrevida foi maior para pacientes com índice de risco do doador menor que 1,7 (63,62% vs 53,70%). A associação deste índice com o escore MELD não mostrou diferença estatística em relação à sobrevida. Observou-se que a falência e disfunção do enxerto foram associadas ao número crescente de critérios expandidos do doador. Os receptores de doadores maiores de 50 anos tiveram menor sobrevida (65,58% vs 38,40%) e o escore delta-MELD não discriminou a sobrevida. CONCLUSÃO: A sobrevida dos receptores a curto e longo prazo é associada a escores MELD acima de 25, ao volume de sangue transfundido, à disfunção do enxerto, à hiponatremia, à idade do doador acima de 50 anos e àqueles doadores com índice de risco do doador acima de 1,7.

BACKGROUND: The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival. AIM: To assess the value of pretransplant MELD in the prediction of posttransplant survival. METHODS: The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh. RESULTS: A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > 20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > 25, blood requirements, recipient creatinine clearance pretransplant and age donor >50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score < 25 had a 68.86%, 50,44% and 41,50% chance for 1, 5 and 10-year survival and > 25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > 1.7 showed 53.7%, 27.71% and 13.85% and index donor risk <1.7 was 63.62%, 51.4% and 44.08%, respectively. Age donor > 50 years showed 38.4%, 26.21% and 13.1% and age donor <50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium. CONCLUSION: In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.

É relatado o caso de paciente grávida, com hepatite C crônica que deu à luz dois gêmeos monozigóticos. Um recém-nascido apresentou positividade para o RNA do vírus da hepatite C (RNA-VHC), no sangue venoso, coletado de veia periférica doze horas após o parto. O outro recém-nascido apresentou-se negativo para o RNA-VHC logo após o nascimento, porém tornou-se RNA-VHC positivo na amostra coletada aos três meses de idade. Os resultados permitem supor que um dos gêmeos provavelmente foi contaminado no período intra-uterino, enquanto o outro adquiriu a infecção no período perinatal. Ambos foram negativos para a presença do RNA-VHC e para os anticorpos anti-HCV em todas as amostras séricas coletadas após os nove meses de idade. Os exames laboratoriais dos gêmeos não mostraram a presença de infecção crônica pelo VHC durante o acompanhamento de 29 meses .

A case of a pregnant patient with chronic hepatitis C who gave birth to monozygotic twins that were infected with HCV is reported. One of the newborns was positive for HCV-RNA in blood sample collected 12 hours after delivery. The other newborn was negative for HCV-RNA at birth, but was detected HCV viremia at three months of age. The results have led to the conclusion that one of the twins was probably contaminated in the intrauterine period, while the other acquired the infection in the perinatal period. Both were negative for HCV-RNA and for anti-HCV in the serum samples collected at nine months of age. The report describes the changes in the laboratory tests conducted in mother and twins until 29 months after delivery.

Entre 1992 e 1997 foram avaliados, ambulatorialmente, 790 doadores de sangue com teste anti-HCV EIA-2 fortemente reagente (relação entre a densidade ótica da amostra / "cut-off" > 3), que haviam sido detectados na triagem sorológica do banco de sangue. Todos eram negativos para doença de Chagas, sífilis, hepatite B (HBsAg) e AIDS. Amostras de sangue foram coletadas, na primeira consulta ambulatorial, para a realização de hemograma, exames bioquímicos e novos testes sorológicos para a HVC (anti-HCV EIA-2). Em 226 doadores anti-HCV EIA-2 repetidamente reagentes, realizou-se o teste suplementar de "immunoblot" para a HVC (RIBA-2). Em 209 doadores, pesquisou-se a presença do RNA do VHC pelo teste do PCR, através de exame automatizado (HCV-AMPLICOR, ROCHE). A ultra-sonografia abdominal foi realizada em 366 doadores e a biópsia hepática em 269 concordantes. Notou-se que 95,6% eram EIA-2 repetidamente reagentes, 94% eram assintomáticos e que apenas 2% referiram icterícia pregressa. Em 47% detectou-se, pelo menos, um fator de risco para a transmissão do VHC, sendo o uso de drogas E.V. o principal deles (27,8%). A transfusão de sangue foi o segundo fator na transmissão da HVC (27,2%). Hepatomegalia foi encontrada em 54%. Esplenomegalia e sinais de hipertensão portal foram raramente encontrados no exame físico, denotando o baixo grau de comprometimento hepático na HVC. A ultra-sonografia abdominal mostrou-se alterada em 65% dos indivíduos, sendo a esteatose a alteração mais freqüentemente observada (50%). Em 83,5% dos doadores submetidos à biópsia hepática, diagnosticou-se hepatite crônica, geralmente classificada como ativa (89%) e de grau leve ou moderado na maioria dos casos (99,5%). O histopatológico foi normal em 1,5% dos doadores. O teste de RIBA-2 e a pesquisa do RNA do VHC pelo PCR foram positivos em, respectivamente, 91,6 e 75% dos doadores anti-HCV EIA-2 reagentes. A pesquisa do RNA do VHC foi positiva em 82% dos indivíduos RIBA-2 reagentes, em 37,5% dos doadores RIBA-2 indeterminados e em 9% dos RIBA-2 negativos. Hepatite crônica foi observada em 50% dos doadores RIBA-2 indeterminados. Entre 18 doadores com alterações mínimas, ao exame histopatológico, 11 (61%) eram positivos para o RNA do VHC. Nossos doadores de sangue anti-HCV reagentes geralmente apresentam alterações clínicas, laboratoriais e histopatológicas próprias de pacientes com hepatites crônicas pelo VHC e uma elevada proporção destes podem ser identificados em entrevistas e avaliação médicas rotineiramente realizadas em bancos de sangue. Geralmente estes doadores infectados pelo VHC somente são identificados e bloqueados pelos resultados dos testes sorológicos.

Between 1992 and 1997, 790 blood donors with anti-HCV EIA-2 strongly reagent (relationship between the sample optical density/cut-off > 3) detected at the blood bank serological screening, were evaluated in ambulatory environment. They were all negative for Chagas disease, syphilis, hepatitis B (HBsAg) and AIDS. Blood samples were collected at the first ambulatorial evaluation, for hemogram, biochemical tests and new serological tests for HCV (anti-HCV EIA-2). In blood samples of 226 repeatedly reagent anti-HCV EIA-2 blood donors, supplementary "immunoblot" test for HCV (RIBA-2) was used. In 209 donors, the presence of HCV-RNA was investigated by the PCR test. The abdominal ultrasonography was realized in 366 donors. In 269 patients liver biopsy was performed for the histopathological study. The follow-up of blood donors showed that 95.6% were repeatedly EIA-2 reagent, 94% were symptomless and denied any hepatitis history, with only 2% mentioning previous jaundice. In 47% of this population at least one risk factor has been detected for the HCV transmission, the use of intravenous drugs being the main one (27.8%). Blood transfusion was the second factor for HCV transmission (27.2%). Hepatomegaly was detected in 54% of the cases. Splenomegaly and signs of portal hypertension have seldom been found in the physical examination, indicating a low degree of hepatic compromising in HCV. Abdominal ultrasound showed alterations in 65% of the subjects, being the steatosis the most frequent (50%). In 83.5% of the donors submitted to the liver biopsy, the histopathological exam showed the presence of chronic hepatitis, usually classified as active (89%) with mild or moderate grade in most of the cases (99.5%). The histopathological exam of the liver was normal in 1.5% of blood donors. The RIBA-2 test and the HCV-RNA investigation by PCR were positive in respectively 91.6 and 75% of the anti-HCV EIA-2 reagent donors. The HCV-RNA research was positive in 82% of the RIBA-2 positive subjects, in 37.5% of the indeterminate RIBA-2 donors and in 9% of the negative RIBA-2 donors. Chronic hepatitis has also been observed in 50% of the histopathological exams of the anti-HCV EIA-2 reagent donors which were indeterminate RIBA-2. Among 18 blood donors with minimal changes histopathological exam 11 (61%) were HCV-RNA positive. Our blood donors anti-HCV reagent generally had clinical, laboratorial and histopathological features observed in patients with chronic HCV hepatitis and a high proportion could be identified in interviews and medical evaluation realized in blood blanks. Generally, these HCV infected donors are identified and discharged only by the serological tests results.

TTV é um vírus DNA recentemente descoberto no Japão a partir de um paciente portador de hepatite pós-transfusional de origem desconhecida. Neste estudo, avaliamos a presença deste vírus em pacientes com hepatopatias crônicas dos estados de São Paulo e do Pará, representando duas regiões geograficamente diferentes. O DNA do TTV foi encontrado em 21/105 (20%) e 9/20 (45%) dos casos de São Paulo e do Pará, respectivamente. O seqüenciamento do DNA amplificado confirmou a presença dos genótipos 1a e 2a , bem como de outros genótipos ainda não descritos até o momento. Em conclusão, TTV está presente em casos de hepatopatias crônicas do Sudeste e do Norte do Brasil. Por outro lado, maiores estudos ainda são necessários antes de se estabelecer relação causal entre o TTV e a hepatite em seres humanos.

TTV is a recently discovered DNA virus, isolated from a patient with post-transfusion hepatitis of unknown etiology by Japanese researchers. In the present study, we evaluated the presence of TTV among chronic liver diseases patients in São Paulo and Pará states, representing two geographically distinct Brazilian regions. TTV DNA was found in 21/105 (20%) and 9/20 (45%) cases from São Paulo and Pará States, respectively. DNA sequence data confirmed the presence of TTV genotypes 1a and 2a, as well as other genotypes not yet described. In conclusion, TTV is present in chronic liver diseases cases from Southeast and North Brazil. However, further studies involving healthy populations are necessary before establishing any causal relationship among TTV and human hepatitis.

A determinação dos níveis de alanina aminostransferase (ALT) tem sido útil para o diagnóstico de hepatopatias. Ultimamente, a elevação dos níveis séricos de ALT em doadores de sangue, tem sido associada a um maior risco de hepatites pós-transfusionais. Este estudo busca identificar os fatores associados com elevados níveis de ALT entre doadores voluntários de sangue e avaliar as relações entre estes aumentos de ALT e o desenvolvimento de infecção pelo vírus da hepatite C. Assim, 116 doadores voluntários de sangue com níveis de ALT elevados, quando da primeira doação, foram estudados. Todos foram questionados sobre hepatopatias prévias, exposição a hepatites, exposição a produtos químicos, uso de drogas ou medicamentos, comportamento sexual, contacto com sangue ou secreções e consumo de álcool. A cada 3 meses foram medidos os níveis de AST, ALT, fosfatase alcalina, gama-glutamil transferase, colesterol, triglicérides e glicemia durante o período de 1-2 anos. Os níveis séricos de hormônios tireoidianos e a presença de auto-anticorpos também foram mensurados. Ultrassonografia abdominal foi realizada em todos os pacientes com elevação persistente dos níveis de AST ou ALT. Foi realizada biópsia hepática em 9 doadores sem diagnóstico definido após investigação clínica. A presença de anticorpos anti-HCV foi novamente pesquisada em 116 doadores no momento da primeira avaliação clínica. Ao final do follow-up (2 anos) 71 doadores foram re-testados para a presença do anti-HCV. Nenhum doador se tornou reagente para os marcadores dos virus da hepatite B ou hepatite C, durante o seguimento. Dos 116 doadores, 101 (87%) mantiveram níveis séricos de ALT persistentemente aumentados. Obesidade e alcoolismo foram as principais condições associadas à elevação dos níveis séricos de ALT em 91/101 (90,1%) doadores. Hipertrigliceridemia, hipercolesterolemia, hipotireoidismo e diabetes mellitus também se associaram a níveis aumentados de ALT. Somente 1/101 (0,9%) apresentou hepatite crônica ativa não A-G e 3/101 (2,9%) apresentaram biópsia hepática com diagnóstico de hepatite reacional. A determinação rotineira dos níveis de ALT, em bancos de sangue não foi útil para detectar doadores infectados com o vírus da hepatite C no Brasil no período que antecede a soroconversão para anti-vhc.

The determination of aminotranferases levels is very useful in the diagnosis of hepatopathies. In recent years, an elevated serum ALT level in blood donors has been associated with an increased risk of post-transfusion hepatitis (PTH). The purpose of the study was to research the factors associated with elevated ALT levels in a cohort of voluntary blood donors and to evaluate the relationship between increased ALT levels and the development of hepatitis C (HCV) infection. 166 volunteer blood donors with elevated ALT at the time of their first donation were studied. All of the donors were questioned about previous hepatopathies, exposure to hepatitis, exposure to chemicals, use of medication or drugs, sexual behaviour, contact with blood or secretions and their intake of alcohol. Every three months, the serum levels of AST, ALT, alkaline phosphatase, gamma glutamyl transpeptidase, cholesterol, triglyceride and glycemia are assessed over a two year follow-up. The serum thyroid hormone levels as well as the presence of auto-antibodies were also measured. Abdominal ultrasound was performed in all patients with persistently elevated ALT or AST levels. A needle biopsy of liver was performed in 9 donors without definite diagnostic after medical investigation. The presence of anti-HCV antibodies in 116 donors were assayed again the first clinical evaluation. At the end of follow-up period (2 years later) 71 donors were tested again for the presence of anti-HCV antibodies. None of donors resulted positive for hepatitis B or hepatitis C markers during the follow-up. Of the 116 donors, 101 (87%) had persistently elevated ALT serum levels during the follow-up. Obesity and alcoholism were the principal conditions related to elevated ALT serum levels in 91/101 (90.1%) donors. Hypertriglyceridemia, hypercholesterolemia, hypothyroidism and diabetes mellitus also were associated with increased ALT levels. Only 1/101 (0.9%) had mild chronic active non A-G viral hepatitis and 3/101 (2.9%) had liver biopsy with non-specific reactive hepatitis. The determination of ALT levels was not useful to detect donors infected with HCV at donation in Brazil, including the initial seronegative anti-HCV phase.