Can aminotransferase-to-platelet ratio index and other non-invasive markers effectively reduce liver biopsies for renal transplant evaluation of hepatitis C virus-positive patients?

Abstract

Our data suggest that there may not currently be a simple and sufficiently accurate non-invasive test to replace liver biopsy in renal transplant workup for HCV-positive patients. The risks outweigh the benefits when it comes to using non-invasive markers like the APRI.

Serum hyaluronic acid in chronic viral hepatitis B and C: a biomarker for assessing liver fibrosis in chronic hemodialysis patients

“…In patients with chronic VHC, FIB4 was found to be better than APRI in evaluating F [31]. Studies on HD patients showed that the major strength of APRI was to exclude significant F, and only 50 % of the patients could be correctly diagnosed [14,28,30]. The assessment of biochemical indices in this patient population could be potentially altered because aminotransferase activity is usually lower in HD patients compared with non-uremic patients [32].…”

“…This was a prospective multicenter transversal and observational study, which included 52 ESRD patients with (14) chronic viral hepatitis B (VHB) and (38) C (VHC) (age: 55.57 ± 14.46 years, dialysis vintage: 132.59 ± 86.02 months) and a control group of 26 patients with ESRD treated by HD, without chronic viral liver disease.…”

“…Patients with chronic viral hepatitis/liver cirrhosis B or C and ESRD treated by HD represent a special patient population because the prevalence of chronic C virus infection is between 9 and 80 % worldwide [1][2][3], and prevalence of chronic B virus infection is 1 % in USA, 9 % in Italy, and up to 15.3 % in Asia [4,5]; liver disease has a more severe evolution, particularly on account of the Abstract Purpose Serum hyaluronic acid (sHA) is studied as a noninvasive marker of liver fibrosis (F) in chronic B and C viral hepatitis in general population but less in end-stage renal disease patients undergoing hemodialysis. Methods We evaluated sHA as a noninvasive biomarker of F in a multicenter prospective, transversal, and observational study which included 52 end-stage renal disease patients with chronic B (14) and C (38) viral hepatitis (age 55.57 ± 14.46 years, dialysis vintage 132.59 ± 86.02 months). Results Of the noninvasive tests analyzed, only sHA, APRI, and FIB4 index were able to differentiate patients with F1 (sHA p = 0.006; APRI p = 0.031; FIB4 p = 0.016).…”

“…In addition, nephrologists hesitate to indicate LPB in patients with ESRD because of platelet dysfunctions and the important risk of hemorrhage. The severity of F can be estimated using biochemical indices such as serum hyaluronic acid (HA), the aspartate aminotransferase-to-platelet ratio index (APRI), the ASAT/ALAT ratio, the Fibrosis 4 score (FIB4) [14,15], and the measurement of liver stiffness with transient elastography (FibroScan) [16,17].…”

How Manage HCV Patients on Hemodialysis?

“…These non-invasive tests have been validated neither in hemodialysis patients nor in kidney transplant recipients, given that they are less accurate than in the general population [17][18][19][20]. The assessment of liver stiffness by elastography is imperfect in this population, even if it is superior in staging the severity of hepatic fibrosis, compared with biochemical markers [20,21].…”