JEAN MICHEL MANSUY - Academia.edu (original) (raw)
Papers by JEAN MICHEL MANSUY
American Journal of Tropical Medicine and Hygiene, Oct 1, 1999
Journal of Hepatology, Apr 1, 2010
POSTERS liver transplantation, death) were not associated with specific viral dominance patterns ... more POSTERS liver transplantation, death) were not associated with specific viral dominance patterns or changes over time. Conclusion: Delta hepatitis is a highly dynamic disease with complex virological patterns. Close monitoring of HBV/HDVinfected patients is suggested even in patients with initially negative HDV-RNA and/or HBV-DNA as reactivations of both viruses may occur requiring distinct treatment approaches, e.g. the use of HBV polymerase inhibitors vs. therapy with type-I interferons.
Gut, Sep 1, 2010
abnormal LFTs. After loss to follow-up, repeat LFTs remained abnormal and a liver biopsy (2009) s... more abnormal LFTs. After loss to follow-up, repeat LFTs remained abnormal and a liver biopsy (2009) showed established cirrhosis with active inflammation. Chronic HEV infection was documented with persisting viraemia in serum and stool over a 3 year period (Jan 2007eJan 2010). HEV was also recovered from his cerebrospinal fluid. He remained antiretroviral naïve until January 2007, when he commenced on tenofovir/emtricitabine and lopinavir/ritonavir. Although transiently switched to efavirenz he settled on his current regimen of abacavir/lamivudine and lopinavir/ritonavir in June 2007. His HIV viral load became undetectable but his CD4 count remained low (100e170 /mm 3). Results In July 2009 he was treated with Pegasys 135 microg/week. His LFTs normalised and his HEV viral load declined. At 6 months he achieved HEV clearance from his serum, but HEV was still detectable in stool. Ribavarin 1 g/day was added in for a further 3 months. HEV viral clearance was achieved from serum and stool. During treatment, neurological symptoms improved and, by the time viral clearance was achieved, they were abolished. He remains HEV PCR negative 3 months after completion of therapy. Conclusion Chronic HEV infection can occur in the context of HIV and can be associated with neurological symptoms. HEV viral clearance can be achieved by combination therapy with Pegasys/ ribavarin, with normalisation of LFT's and resolution of neurological symptoms. The mechanism of neurological damage in HEV infection is uncertain.
Parasite, Sep 1, 1997
The presence of schistosomiasis mansoni is known in Martinique since the beginning of the XXth ce... more The presence of schistosomiasis mansoni is known in Martinique since the beginning of the XXth century. A general survey of the distribution of the disease was carried out in 1977 and showed a mean prevalence of 12 % (coprology and serology taken together) in the whole of the island. Following this survey, an integrated control programme associating sanitary education, detection and treatment of patients and improved sanitation, was developed. In addition, a biological control programme against the intermediate snail host, Biomphalaria glabrata using the competitor snail, Melanoides tuberculata, was developed in the transmission sites. The decline of snail populations and of its parasite, as well as a strong reduction of the prevalence in humans were recorded between 1977 and 1996. At the present time, only few cases corresponding to older infections are detected. This epidemiological situation is quite different from that in Guadeloupe island where, in spite of an excellent control programme which was achieved on the Basse-Terre district, an important focus is still functionning on Grande-Terre district with the black rat as host reservoir. Such foci do not exist on Martinique island.
Journal of Clinical Virology, May 1, 2010
Gastroenterologie Clinique Et Biologique, Mar 1, 2009
Transfusion Clinique Et Biologique, Sep 1, 2017
HEV infections are mainly food- and water-borne but transfusion-transmission has occurred in both... more HEV infections are mainly food- and water-borne but transfusion-transmission has occurred in both developing and developed countries. The infection is usually asymptomatic but it can lead to fulminant hepatitis in patients with underlying liver disease and pregnant women living in developing countries. It also causes chronic hepatitis E, with progressive fibrosis and cirrhosis, in approximately 60% of immunocompromised patients infected with HEV genotype 3. The risk of a transfusion-transmitted HEV infection is linked to the frequency of viremia in blood donors, the donor virus load and the volume of plasma in the final transfused blood component. Several developed countries have adopted measures to improve blood safety based on the epidemiology of HEV.
Eurosurveillance, May 12, 2016
In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) inf... more In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) infection with 1,152 cases reported mainly in hospitalised children with severe asthma or bronchiolitis. Following the US alert, 11 laboratories of the French enterovirus (EV) surveillance network participated in an EV-D68 survey. A total of 6,229 respiratory samples, collected from 1 July to 31 December 2014, were screened for EV-D68 resulting in 212 EV-D68-positive samples. These 212 samples corresponded to 200 EV-D68 cases. The overall EV-D68 positivity rates among respiratory samples were of 5% (184/3,645) and 1.1% (28/2,584) in hospitalised children and adults respectively. The maximum weekly EV-D68 positivity rates were of 16.1% for children (n = 24/149; week 43) and 2.6% for adults (n = 3/115; week 42). Of 173 children with EV-D68 infection alone, the main symptoms were asthma (n = 83; 48.0%) and bronchiolitis (n = 37; 21.4%). One child developed acute flaccid paralysis (AFP) following EV-D68-associated pneumonia. Although there was no significant increase in severe respiratory tract infections reported to the French public health authorities, 10.7% (19/177) of the EV-D68 infected children and 14.3% (3/21) of the EV-D68 infected adults were hospitalised in intensive care units. Phylogenetic analysis of the viral protein 1 (VP1) sequences of 179 EV-D68 cases, revealed that 117 sequences (65.4%), including that of the case of AFP, belonged to the B2 variant of clade B viruses. Continuous surveillance of EV-D68 infections is warranted and could benefit from existing influenza-like illness and EV surveillance networks.
Journal of Hepatology, Apr 1, 2006
![Research paper thumbnail of [161] Hepatitis e Virus Infection Can Evolve to Chronic Hepatitis in Organ-Transplant Patients](https://attachments.academia-assets.com/110254181/thumbnails/1.jpg)
](Journal of Hepatology, Apr 1, 2007
Background and Aims: Although transarterial chemotherapy is attempted to retard tumor progression... more Background and Aims: Although transarterial chemotherapy is attempted to retard tumor progression in hepatocellular carcinoma (HCC) patients awaiting orthotopic liver transplantation (OLT), information regarding the appropriate patient selection for the therapy and its efficacy is lacking. This study was conducted to address the practical issues of how long HCC patients would remain adequately within the restrictive criteria with transarterial chemotherapy and of which patients could hold the longest acceptable waiting time as the best candidates for such therapy. Methods: In total, 180 consecutive patients meeting the Milan criteria were included in the study. Transarterial chemo-lipiodolization using epirubicin 50mg/m2 and/or cisplatin 60mg/m2 was repeated at one-totwo monthly intervals, until donor liver was available. From the analyses of dropouts from the list, acceptable waiting times prior to OLT and best candidates for pretransplant transarterial therapy were explored. Results: During the follow-up, 70 (38.9%) patients dropped off the waiting list. The median time to dropout was significantly shorter in Child-Pugh class B/C than in A patients (17.0 vs. 33.3 months, P 1 0.001). Risk factor analysis identified Child-Pugh classification to be the strongest predictor of dropouts (P 1 0.00 1). On multivariate analysis, alpha-fetoprotein (AFP) level >lo0 ngiml, tumor size >3 cm and multiple nodules remained independent predictors of dropout for Child A group (all P < 0.05), whereas none were predictive of dropout for Child B/C group. Child A patients with single nodule of 1 3 cm and AFP 1 I00 ngiml were found to be at the lowest risk of dropout, with only 22.5% dropout rate up to 41 months. Dropout due to death was significantly frequent in Child B/C than Child A group (32.5% vs. 3.6%, P<0.001), whereas dropout due to tumor progression were similar between the two groups. Conclusions: The acceptable waiting times prior to OLT appear to be around 3 and 1.5 years for Child A and B/C groups undergoing transarterial chemotherapy, respectively. Thus, OLT should be considered within these periods, according to Child-Pugh classification. Child class A patients with one nodule of 1 3 cm and AFP 1 100 ngiml may be the best candidates for pretransplant chemo-lipiodolization, being at the lowest risk of dropout.
Gut, Sep 1, 2010
markers for viral hepatitis. Four (2.2%) patients required treatment interruption due to elevated... more markers for viral hepatitis. Four (2.2%) patients required treatment interruption due to elevated LFTs, none of whom had serological markers of viral hepatitis. Conclusion In our West London cohort, TB patients are a high risk group for HBV and HCV carriage. We found no increased risk of DILI in patients with markers of viral hepatitis undergoing anti-TB therapy. Screening for viral hepatitis in high risk groups is advocated by several international associations. However, testing for HBV and HCV in TB patients is not routine practice in the UK. Larger studies are required to identify the highest risk groups within TB populations. Until then, we recommend that screening for viral hepatitis is considered in all patients with TB.
Gastroenterologie Clinique Et Biologique, Jun 1, 2009
Clinical Infectious Diseases
We used variant typing polymerase chain reaction to describe the evolution of severe acute respir... more We used variant typing polymerase chain reaction to describe the evolution of severe acute respiratory syndrome coronavirus 2 Omicron sublineages between December 2021 and mid-March 2022. The selective advantage of the BA.2 variant over BA.1 is not due to greater nasopharyngeal viral loads.
Médecine et Maladies Infectieuses, 1996
Transplantation, 2010
Background. Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-o... more Background. Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-organ transplant patients. Methods. We identified 33 cases of autochthonous acute HEV infection in solid-organ transplant patients. Results. Among 27 HEV-positive patients, who had a follow-up of more than 6 months, 16 (59.25%) evolved to chronic HEV infection, defined by persisting elevated liver-enzyme levels and positive serum HEV RNA 6 months after diagnosis. Serial liver biopsies showed progression in liver activity and liver fibrosis. Three patients developed liver cirrhosis. The proportion of patients receiving tacrolimus compared with cyclosporine A was significantly higher in patients who evolved to chronic disease. Immunosuppressive therapy was reduced in patients with chronic hepatitis; however, those who had a dramatic decrease in tacrolimus trough levels were more likely to clear the virus. Four chronic liver transplant patients were cleared off the virus at 14, 16, 22, and 23 months after diagnosis. At last follow-up, their tacrolimus trough levels and daily steroid doses were significantly lower than those who remained viremic. These four patients had lower liver-enzyme levels and lower activity scores on liver biopsies, and their peripheral blood CD3-and CD4-positive cell counts were also significantly higher. Conclusions. The rate of chronic HEV-related hepatitis is approximately 60% in solid-organ transplant patients. When possible, the reduction of immunosuppressive drugs targeting T cells should be considered as a first-line therapeutic option.
Nephrology Dialysis Transplantation, 2010
Hepatitis E virus (HEV) can induce chronic hepatitis in immunosuppressed patients. There is no es... more Hepatitis E virus (HEV) can induce chronic hepatitis in immunosuppressed patients. There is no established treatment for HEV infection. Pegylated interferon-alpha-2a (Peg-IFN-α-2a) has been successfully used for treating HEV infection in liver transplant patients with chronic hepatitis. A kidney transplant patient with chronic HEV
Archives de Pédiatrie, 2009
American Journal of Transplantation, 2008
Hepatitis E virus (HEV) infection was thought to be responsible for acute hepatitis that did not ... more Hepatitis E virus (HEV) infection was thought to be responsible for acute hepatitis that did not become chronic. However, we have recently reported that HEV infection can evolve to chronic hepatitis, at least in solid-organ transplant patients. We report on two cases of rapidly progressive of HEV-related cirrhosis that occurred in two organ-transplant patients. Case 1: A kidney-pancreas-transplant patient developed acute HEV hepatitis 60 months after transplantation, which evolved to chronicity as defined by persisting elevated liver-enzyme levels and positive serum HEV RNA. At 22 months after the acute phase, she presented with cirrhosis and portal hypertension, that is ascites and esophagus varices. Case 2: A kidney-transplant patient developed acute hepatitis 36 months after transplantation, which persisted and remained unexplained for 38 months. Then, HEV RNA was searched for in their serum and stools, and was found to be positive in both. Retrospective analysis of available stored serum, mainly the serum obtained at the acute phase, confirmed the diagnosis of chronic hepatitis E. In both cases, a liver biopsy showed cirrhosis. We conclude that HEV infection cannot only evolve to chronic hepatitis, but can also be responsible for rapidly progressing cirrhosis in organ-transplant patients.
American Journal of Tropical Medicine and Hygiene, Oct 1, 1999
Journal of Hepatology, Apr 1, 2010
POSTERS liver transplantation, death) were not associated with specific viral dominance patterns ... more POSTERS liver transplantation, death) were not associated with specific viral dominance patterns or changes over time. Conclusion: Delta hepatitis is a highly dynamic disease with complex virological patterns. Close monitoring of HBV/HDVinfected patients is suggested even in patients with initially negative HDV-RNA and/or HBV-DNA as reactivations of both viruses may occur requiring distinct treatment approaches, e.g. the use of HBV polymerase inhibitors vs. therapy with type-I interferons.
Gut, Sep 1, 2010
abnormal LFTs. After loss to follow-up, repeat LFTs remained abnormal and a liver biopsy (2009) s... more abnormal LFTs. After loss to follow-up, repeat LFTs remained abnormal and a liver biopsy (2009) showed established cirrhosis with active inflammation. Chronic HEV infection was documented with persisting viraemia in serum and stool over a 3 year period (Jan 2007eJan 2010). HEV was also recovered from his cerebrospinal fluid. He remained antiretroviral naïve until January 2007, when he commenced on tenofovir/emtricitabine and lopinavir/ritonavir. Although transiently switched to efavirenz he settled on his current regimen of abacavir/lamivudine and lopinavir/ritonavir in June 2007. His HIV viral load became undetectable but his CD4 count remained low (100e170 /mm 3). Results In July 2009 he was treated with Pegasys 135 microg/week. His LFTs normalised and his HEV viral load declined. At 6 months he achieved HEV clearance from his serum, but HEV was still detectable in stool. Ribavarin 1 g/day was added in for a further 3 months. HEV viral clearance was achieved from serum and stool. During treatment, neurological symptoms improved and, by the time viral clearance was achieved, they were abolished. He remains HEV PCR negative 3 months after completion of therapy. Conclusion Chronic HEV infection can occur in the context of HIV and can be associated with neurological symptoms. HEV viral clearance can be achieved by combination therapy with Pegasys/ ribavarin, with normalisation of LFT's and resolution of neurological symptoms. The mechanism of neurological damage in HEV infection is uncertain.
Parasite, Sep 1, 1997
The presence of schistosomiasis mansoni is known in Martinique since the beginning of the XXth ce... more The presence of schistosomiasis mansoni is known in Martinique since the beginning of the XXth century. A general survey of the distribution of the disease was carried out in 1977 and showed a mean prevalence of 12 % (coprology and serology taken together) in the whole of the island. Following this survey, an integrated control programme associating sanitary education, detection and treatment of patients and improved sanitation, was developed. In addition, a biological control programme against the intermediate snail host, Biomphalaria glabrata using the competitor snail, Melanoides tuberculata, was developed in the transmission sites. The decline of snail populations and of its parasite, as well as a strong reduction of the prevalence in humans were recorded between 1977 and 1996. At the present time, only few cases corresponding to older infections are detected. This epidemiological situation is quite different from that in Guadeloupe island where, in spite of an excellent control programme which was achieved on the Basse-Terre district, an important focus is still functionning on Grande-Terre district with the black rat as host reservoir. Such foci do not exist on Martinique island.
Journal of Clinical Virology, May 1, 2010
Gastroenterologie Clinique Et Biologique, Mar 1, 2009
Transfusion Clinique Et Biologique, Sep 1, 2017
HEV infections are mainly food- and water-borne but transfusion-transmission has occurred in both... more HEV infections are mainly food- and water-borne but transfusion-transmission has occurred in both developing and developed countries. The infection is usually asymptomatic but it can lead to fulminant hepatitis in patients with underlying liver disease and pregnant women living in developing countries. It also causes chronic hepatitis E, with progressive fibrosis and cirrhosis, in approximately 60% of immunocompromised patients infected with HEV genotype 3. The risk of a transfusion-transmitted HEV infection is linked to the frequency of viremia in blood donors, the donor virus load and the volume of plasma in the final transfused blood component. Several developed countries have adopted measures to improve blood safety based on the epidemiology of HEV.
Eurosurveillance, May 12, 2016
In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) inf... more In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) infection with 1,152 cases reported mainly in hospitalised children with severe asthma or bronchiolitis. Following the US alert, 11 laboratories of the French enterovirus (EV) surveillance network participated in an EV-D68 survey. A total of 6,229 respiratory samples, collected from 1 July to 31 December 2014, were screened for EV-D68 resulting in 212 EV-D68-positive samples. These 212 samples corresponded to 200 EV-D68 cases. The overall EV-D68 positivity rates among respiratory samples were of 5% (184/3,645) and 1.1% (28/2,584) in hospitalised children and adults respectively. The maximum weekly EV-D68 positivity rates were of 16.1% for children (n = 24/149; week 43) and 2.6% for adults (n = 3/115; week 42). Of 173 children with EV-D68 infection alone, the main symptoms were asthma (n = 83; 48.0%) and bronchiolitis (n = 37; 21.4%). One child developed acute flaccid paralysis (AFP) following EV-D68-associated pneumonia. Although there was no significant increase in severe respiratory tract infections reported to the French public health authorities, 10.7% (19/177) of the EV-D68 infected children and 14.3% (3/21) of the EV-D68 infected adults were hospitalised in intensive care units. Phylogenetic analysis of the viral protein 1 (VP1) sequences of 179 EV-D68 cases, revealed that 117 sequences (65.4%), including that of the case of AFP, belonged to the B2 variant of clade B viruses. Continuous surveillance of EV-D68 infections is warranted and could benefit from existing influenza-like illness and EV surveillance networks.
Journal of Hepatology, Apr 1, 2006
Journal of Hepatology, Apr 1, 2007
Background and Aims: Although transarterial chemotherapy is attempted to retard tumor progression... more Background and Aims: Although transarterial chemotherapy is attempted to retard tumor progression in hepatocellular carcinoma (HCC) patients awaiting orthotopic liver transplantation (OLT), information regarding the appropriate patient selection for the therapy and its efficacy is lacking. This study was conducted to address the practical issues of how long HCC patients would remain adequately within the restrictive criteria with transarterial chemotherapy and of which patients could hold the longest acceptable waiting time as the best candidates for such therapy. Methods: In total, 180 consecutive patients meeting the Milan criteria were included in the study. Transarterial chemo-lipiodolization using epirubicin 50mg/m2 and/or cisplatin 60mg/m2 was repeated at one-totwo monthly intervals, until donor liver was available. From the analyses of dropouts from the list, acceptable waiting times prior to OLT and best candidates for pretransplant transarterial therapy were explored. Results: During the follow-up, 70 (38.9%) patients dropped off the waiting list. The median time to dropout was significantly shorter in Child-Pugh class B/C than in A patients (17.0 vs. 33.3 months, P 1 0.001). Risk factor analysis identified Child-Pugh classification to be the strongest predictor of dropouts (P 1 0.00 1). On multivariate analysis, alpha-fetoprotein (AFP) level >lo0 ngiml, tumor size >3 cm and multiple nodules remained independent predictors of dropout for Child A group (all P < 0.05), whereas none were predictive of dropout for Child B/C group. Child A patients with single nodule of 1 3 cm and AFP 1 I00 ngiml were found to be at the lowest risk of dropout, with only 22.5% dropout rate up to 41 months. Dropout due to death was significantly frequent in Child B/C than Child A group (32.5% vs. 3.6%, P<0.001), whereas dropout due to tumor progression were similar between the two groups. Conclusions: The acceptable waiting times prior to OLT appear to be around 3 and 1.5 years for Child A and B/C groups undergoing transarterial chemotherapy, respectively. Thus, OLT should be considered within these periods, according to Child-Pugh classification. Child class A patients with one nodule of 1 3 cm and AFP 1 100 ngiml may be the best candidates for pretransplant chemo-lipiodolization, being at the lowest risk of dropout.
Gut, Sep 1, 2010
markers for viral hepatitis. Four (2.2%) patients required treatment interruption due to elevated... more markers for viral hepatitis. Four (2.2%) patients required treatment interruption due to elevated LFTs, none of whom had serological markers of viral hepatitis. Conclusion In our West London cohort, TB patients are a high risk group for HBV and HCV carriage. We found no increased risk of DILI in patients with markers of viral hepatitis undergoing anti-TB therapy. Screening for viral hepatitis in high risk groups is advocated by several international associations. However, testing for HBV and HCV in TB patients is not routine practice in the UK. Larger studies are required to identify the highest risk groups within TB populations. Until then, we recommend that screening for viral hepatitis is considered in all patients with TB.
Gastroenterologie Clinique Et Biologique, Jun 1, 2009
Clinical Infectious Diseases
We used variant typing polymerase chain reaction to describe the evolution of severe acute respir... more We used variant typing polymerase chain reaction to describe the evolution of severe acute respiratory syndrome coronavirus 2 Omicron sublineages between December 2021 and mid-March 2022. The selective advantage of the BA.2 variant over BA.1 is not due to greater nasopharyngeal viral loads.
Médecine et Maladies Infectieuses, 1996
Transplantation, 2010
Background. Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-o... more Background. Hepatitis-E virus (HEV) infection can be responsible for chronic hepatitis in solid-organ transplant patients. Methods. We identified 33 cases of autochthonous acute HEV infection in solid-organ transplant patients. Results. Among 27 HEV-positive patients, who had a follow-up of more than 6 months, 16 (59.25%) evolved to chronic HEV infection, defined by persisting elevated liver-enzyme levels and positive serum HEV RNA 6 months after diagnosis. Serial liver biopsies showed progression in liver activity and liver fibrosis. Three patients developed liver cirrhosis. The proportion of patients receiving tacrolimus compared with cyclosporine A was significantly higher in patients who evolved to chronic disease. Immunosuppressive therapy was reduced in patients with chronic hepatitis; however, those who had a dramatic decrease in tacrolimus trough levels were more likely to clear the virus. Four chronic liver transplant patients were cleared off the virus at 14, 16, 22, and 23 months after diagnosis. At last follow-up, their tacrolimus trough levels and daily steroid doses were significantly lower than those who remained viremic. These four patients had lower liver-enzyme levels and lower activity scores on liver biopsies, and their peripheral blood CD3-and CD4-positive cell counts were also significantly higher. Conclusions. The rate of chronic HEV-related hepatitis is approximately 60% in solid-organ transplant patients. When possible, the reduction of immunosuppressive drugs targeting T cells should be considered as a first-line therapeutic option.
Nephrology Dialysis Transplantation, 2010
Hepatitis E virus (HEV) can induce chronic hepatitis in immunosuppressed patients. There is no es... more Hepatitis E virus (HEV) can induce chronic hepatitis in immunosuppressed patients. There is no established treatment for HEV infection. Pegylated interferon-alpha-2a (Peg-IFN-α-2a) has been successfully used for treating HEV infection in liver transplant patients with chronic hepatitis. A kidney transplant patient with chronic HEV
Archives de Pédiatrie, 2009
American Journal of Transplantation, 2008
Hepatitis E virus (HEV) infection was thought to be responsible for acute hepatitis that did not ... more Hepatitis E virus (HEV) infection was thought to be responsible for acute hepatitis that did not become chronic. However, we have recently reported that HEV infection can evolve to chronic hepatitis, at least in solid-organ transplant patients. We report on two cases of rapidly progressive of HEV-related cirrhosis that occurred in two organ-transplant patients. Case 1: A kidney-pancreas-transplant patient developed acute HEV hepatitis 60 months after transplantation, which evolved to chronicity as defined by persisting elevated liver-enzyme levels and positive serum HEV RNA. At 22 months after the acute phase, she presented with cirrhosis and portal hypertension, that is ascites and esophagus varices. Case 2: A kidney-transplant patient developed acute hepatitis 36 months after transplantation, which persisted and remained unexplained for 38 months. Then, HEV RNA was searched for in their serum and stools, and was found to be positive in both. Retrospective analysis of available stored serum, mainly the serum obtained at the acute phase, confirmed the diagnosis of chronic hepatitis E. In both cases, a liver biopsy showed cirrhosis. We conclude that HEV infection cannot only evolve to chronic hepatitis, but can also be responsible for rapidly progressing cirrhosis in organ-transplant patients.