Toga virus‐like particles (typically 60‐70 nm: enveloped with small surface spikes) were detected in the native hepatectomy specimens in 7 of 18 patients grafted for acute liver failure attributed to sporadic non‐A, non‐B hepatitis and in 2 patients grafted for fulminant hepatitis attributed to anti‐epileptic drug hepatotoxicity. These particles were not detected in the hepatectomies from 12 other patients grafted for other causes of acute liver failure, 12 for various chronic liver diseases, and 2 histologically normal livers. Acute hepatic failure, characterized histologically by severe haemorrhagic necrosis, developed 7 days after grafting in 5 patients, all in the non‐A, non‐B group with toga virus‐like particles in native liver. Similar virus‐like particles were detected in all grafts and were in greater abundance than in the native livers. The agent may be novel because pre‐ and post‐grafting sera were negative for antibodies against representative panels of arboviruses and in first and second generation antibody tests for hepatitis C virus. © 1992 Wiley‐Liss, Inc.
- electron microscopy
- haemorrhagic necrosis
- hepatitis C virus
- recurrent acute liver failure