anti-hepatitis C virus (HCV) antibody in patients with liver disease who deny risk factors for exposure remains unclear. A previous American study documented that 40% of HCV carriers have no identifiable risk factor for HCV transmission (1). This argues in favour of such testing. However, a recent study (2) from the United States suggests that one-to-one physician/patient interviews can elicit at least one risk factor in over 90% of patients. If this is substantiated, screening for HCV in patients who deny all risk factors is unlikely to be worthwhile. The purpose of the present study was to address this question as it applies to Canadian patients with chronic HCV infections. PATIENTS AND METHODSThe charts of all patients seen at the Liver Diseases Unit, Health Sciences Centre, Winnipeg, Manitoba, from 1987-93 with a diagnosis of HCV infection were reviewed for accuracy of diagnosis and the patient's responses to a series of standard questions posed by a physician during one-to-one interviews at the initial evaluation. Only patients who were anti-HCV positive by second generation screening and supplemental assays were included in the study. The questions asked with respect to risk factors for HCV transmission included: have you ever received a blood or blood product transfusion?; have you HEPATOLOGY GY MINUK, WWS WONG, KDE KAITA, BG ROSSER. Risk factors for hepatitis C virus infection in Canadian patients with chronic type C hepatitis. Can J Gastroenterol 1995;9(3):137-140. Previous reports from the United States indicate that as many as 40% of patients with chronic hepatitis C virus (HCV) have no identifiable risk factor for HCV infection. To determine whether the same is true of Canadian patients with chronic HCV the records of 89 anti-HCV positive patients referred to the authors' tertiary care centre for evaluation of liver disease were reviewed. Each patient had been specifically asked about the following risk factors: previous blood transfusions; intravenous drug abuse; homosexual activity; sexual promiscuity (multiple sexual partners or a history of sexually transmitted diseases); tattoos made with nonsterile techniques; and ear piercing using nonsterile techniques. The results of the study revealed that 76 of 89 patients (85%) had at least one risk factor for HCV exposure, 38 (43%) had only one risk factor, 19 (21%) had two, 12 (14%) had three and the remaining three patients (3%) had four. The most common risk factor was a history of intravenous drug abuse (30 of 89 patients, 34%) followed by sexual promiscuity (28, 32%), previous blood transfusions (21, 24%), tattoos (17, 19%), homosexual contacts (seven, 8%) and ear piercing (five, 6%). Contrary to a recent report identifying sexual contact as an independent risk factor for HCV infection, only four cases (5%) were found where sexual promiscuity was identified as the only risk factor. In conclusion, these findings indicate that a possible source of HCV infection can be identified in a large majority of Canadians referred to an urban centre with chronic ...

Care of the growing number of liver transplant recipients will increasingly fall on the referring centres. Thus, there is a need to define more clearly the demographic, clinical and laboratory profiles of liver transplant recipients, particularly in the setting of a centre where a liver transplantation program does not exist. The present study documented these features in 37 patients attending an adult ambulatory care clinic in an urban, nonliver transplant centre. Mean +/- SD age of the study population was 44 +/- 11.9 years. Twenty-one patients (57%) were male. Annual enrolment in the clinic increased from three patients at the completion of the clinic's first year (1988) to 16 patients in the final year of the study (1993). Time between the transplantation procedure and the patient's return to the referring centre decreased from a mean of 12 weeks in 1988 to four weeks in 1993. During those seven years no patient required an unscheduled return to the transplant centre for surgical complications or problems associated with immuno-suppressive therapy. In conclusion, these data provide a profile of liver transplant patients attending a nonliver transplant centre for follow-up and support the concept that nontransplant centres are capable of providing safe and, in terms of travel, less expensive care for liver transplant recipients.