Chronic cryptogenic

Carlson ), Eriksson S. Chronic cryptogenic Ever disease and malignant hepatoma in intermediate alphai. antitrypsin deficiency identified by a Pi Z-spe-cific monoclonal antibody. Scand J Gastroenterol 1985 20 835-42. 

The main indications for liver transplantation include chronic hepatitis C, alcoholic liver disease, nonalcoholic fatty liver disease, and cryptogenic cirrhosis. 

Cryptogenic cirrhosis Chronic viral hepatitis Non-alcoholic steatohepatitis (NASH)... 

In acute viral hepatitis C, the HCV RNA usually clears from the serum once the infection is over — although the anti-HCV test remains positive for a long time after this. However, the combination of increased GPT and a positive anti-HCV test of the first generation nearly always points to infectious HCV. Subsequent to the EIA test, 95% of the positive sera demonstrated cRNA by PCR, so that infectivity could be confirmed. Eor this reason, neither anti-HCV-positive blood donors nor blood units can be released for transfusion. As a check for hepatitis B-negative patients with liver cell carcinoma, the EIA test displayed positivity in 83% of cases. In patients with aetiologically unresolved cirrhosis, the EIA test was positive in 62% of cases, i. e. a large number of the cryptogenic chronic cases of hepatitis and cirrhosis were probably caused by HCV infection. 

Hollingsworth, R.C., Minton, E.J., Fraser-Moodie, C., Metivier, E., Rizzi, P.M., Irving, W.L., Jenkins, D., Ryder, S.D. Hepatitis G infection role in cryptogenic chronic liver disease and primary liver cell cancer in the UK. J. Vir. Hepat. 1998 5 165-169... 

From present knowledge, it can be assumed that numerous cases of cryptogenic chronic hepatitis or cryptogenic cirrhosis are attributable to the presence of NASH in terms of aetiopathogenesis. 

Cryptogenic chronic hepatitis is part of the outlier syndrome it is serologically unclassifiable. The condition of such patients is, however, similar to AIH. They often show positive evidence of SLR... 

Type 3 is characterized by the positivity of LP/SLA. These antibodies are the only type found in 25% of patients with AIH. Sometimes, SMA, ANA and ASGPR can also be detected, but at low titre levels. The frequency is 5-10%. Women are affected five times more often than men. There is a high concentration of y-globu-lin. HCV antibodies were found in 11% of patients. (37) The clinical course is similar to type 1 as a rule, it progresses rapidly. The response to immunosuppressives is good. Cryptogenic chronic hepatitis can often be diagnosed with the help of LP/SLA. (s. tab. 33.1)... 

Occasionally, forms of autoantibody-negative chronic hepatitis are found with no detectable cause. They resemble autoimmune hepatitis in every respect and respond well to corticosteroid therapy. This special group (10-15%) possibly comprises cases of autoimmune hepatitis for which no immunoserologic markers are known as yet. In numerous cases of cryptogenic chronic hepatitis, AIH type 3 can be detected due to evidence of high-titric LP/LSA. 

At the end of the morphological development of chronic hepatitis, aetiologically defined cirrhosis occurs in a certain percentage of cases. In this connection, no primary cirrhosis exists (as with the exclusively historical term primary biliary cirrhosis). Even though cryptogenic cirrhosis may be in evidence, the term primary is not acceptable because cirrhosis is not a primary occurrence ... 

Hodges J, MiUward-Sadler G, Barbatis C, Wright R, Heterozygous MZ alpha 1-antitrypsin deficiency in adults with chronic active hepatitis and cryptogenic cirrhosis. N Engl J Med 1981 304 557-60. 

Includes alcoholic and cryptogenic cirrhosis, acute viral and active chronic hepatitis. 

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