Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation

• Published in: The American journal of gastroenterology Vol. 94; no. 12; pp. 3576 - 3582
• Main Authors: STERLING, R. K, SANYAL, A. J, LUKETIC, V. A, STRAVITZ, R. T, KING, A. L, POST, A. B, MILLS, A. S, CONTOS, M. J, SHIFFMAN, M. L
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing 01.12.1999
• Subjects: Adult; AIDS/HIV; Alanine Transaminase - blood; Biological and medical sciences; Disease Progression; Female; Hepatitis C virus; Hepatitis C, Chronic - pathology; Human viral diseases; Humans; Infectious diseases; Kidney Failure, Chronic - pathology; Kidney Transplantation - pathology; Liver - pathology; Liver Cirrhosis - pathology; Liver Function Tests; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Viral diseases; Viral hepatitis; Viral Load; Waiting Lists; Kidney disease; Human; Urinary system disease; Viremia; Liver; Hepatic disease; Exploration; Terminal stage; Histology; Infection; Pathology; Chronic; Viral disease; Renal failure; Digestive diseases; Complication; Viral hepatitis C
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.1999.01649.x

Hepatitis C virus (HCV) is common in patients with end stage renal disease (ESRD) awaiting renal transplantation (RT). However, few data are available on the liver histology and viral titer in these patients relative to patients with HCV and normal renal function. The aims of this study were to assess liver histology, quantitative HCV-RNA titer, and alanine aminotransferase (ALT) levels in patients with ESRD awaiting RT, and to identify clinical predictors of histological progression to advanced bridging fibrosis and/or cirrhosis. A total of 50 consecutive patients (mean age 42 yr, 62% male) with ESRD and HCV, who were awaiting RT, underwent liver biopsy. Two HCV populations, one with persistently normal ALT and another with elevated ALT, both with normal renal function, served as controls. HCV-RNA titer was assessed by quantitative PCR. Of the patients with ESRD, 94% had normal ALT. Log HCV RNA titer was significantly higher in patients with ESRD (5.8+/-0.3) than in either normal ALT (5.4+/-0.1) or elevated ALT (5.3+/-0.1) controls (p < 0.05). Knodell Histological Activity Index (HAI) in patients with ESRD was similar to that observed in control patients with normal ALT (4.8+/-0.4 vs 4.9+/-0.4) but significantly less (p < 0.05) than that observed in control patients with elevated ALT (8.4+/-0.5). The percentage of patients with bridging fibrosis or cirrhosis was similar in patients with ESRD and controls with persistently normal ALT (22% vs 13%) but significantly less (p < 0.001) than that observed in control patients with elevated ALT (48%). No significant differences in ALT, HCV-RNA titer, duration on hemodialysis, or time from first possible exposure was observed between ESRD patients with advance fibrosis (n = 11) and those with mild disease (n = 39). Our data suggest that liver biopsy is necessary to exclude significant liver pathology in patients with HCV and ESRD, and to help define those patients in whom interferon treatment might be helpful.