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Minneapolis: University of Minnesota, 1989. 42. Crabtree BF, Miller WL. Doing qualitative research. London: Sage Publi- cations, 1992. 43. Reference deleted. 44. Morasso G, Alberisio A, Capelli M, Rossi C, Baracco G, Costantini M. Illness awareness in cancer patients: a conceptual framework and a preliminary classification hypothesis. Psychooncology 1997; 6: 212. Received 1 June 2001. Revision Requested 10 August 2001. Accepted 23 November 2001. 0041-1337/02/7310-1635/0 TRANSPLANTATION Vol. 73, 1635–1639, No. 10, May 27, 2002 Copyright © 2002 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. A ROLE FOR CHRONIC PARVOVIRUS B19 INFECTION IN LIVER DYSFUNCTION IN RENAL TRANSPLANT RECIPIENTS? PO-CHANG LEE, 1,2 CHUNG-JYE HUNG, 2 YIH-JYH LIN, 2 JEN-REN WANG, 3 MING-SHIOU JAN, 4 AND HUAN-YAO LEI 5 Departments of Surgery, Medical Technology, and Immunology, College of Medicine, National Cheng Kung University, and Pharmacy Department, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background. Clinically, liver dysfunction in renal transplant recipients is related to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The con- tribution of parvovirus B19 (B19) to liver disease in renal transplant recipients has not been studied. Here we present the association of liver dysfunction with or without the coinfection of B19, HBV, and HCV after renal transplantation. Methods. We used enzyme-linked immunosorbent as- say to identify B19, HBV, and HCV infections in serum samples taken from 144 renal transplant recipients before transplantation and at 12 and 24 months after transplantation. After each patient had fasted for 12 hr, blood was taken for measurement of aspartate ami- notransferase and alanine aminotransferase monthly for at least 6 months. Results. Liver dysfunction developed at the signifi- cantly higher incidence of 47% in the anti-HCV() pa- tients compared with 6% in the noninfected group (P<0.0001). HBV infection had no impact on the inci- dence of liver dysfunction in renal transplant recipi- ents. A higher incidence of liver dysfunction was found in 42% of B19 IgG()IgM() group patients com- pared with 13% of the B19 IgG()IgM() group (P0.0051) and 9.5% of the B19 IgG()IgM() group (P0.0003). A B19 polymerase chain reaction (PCR) assay revealed significantly higher liver dysfunction in 29% of B19 PCR() group patients compared with 13.6% of B19 PCR() patients (P0.0419). Patients who were anti-HCV() and B19 PCR() had a significantly higher incidence of liver dysfunction than B19 PCR() patients (P0.002). Conclusions. Chronic B19 infection and HCV infec- tion, both separately and in combination, increase the incidence of liver dysfunction in renal transplant recip- ients. HBV infection does not seem to be independently or synergistically associated with liver dysfunction. 1 Address correspondence to: Po-Chang Lee, MD, Department of Surgery, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan, Taiwan 704. E-mail: pochang@mail.ncku.edu.tw. 2 Department of Surgery, College of Medicine, National Cheng Kung University. 3 Department of Medical Technology, College of Medicine, Na- tional Cheng Kung University. 4 Pharmacy Department, Chia Nan University of Pharmacy and Science. 5 Department of Immunology, College of Medicine, National Cheng Kung University. LEE ET AL. May 27, 2002 1635