Histopathological Impacts of Hepatitis Virus Infection in Hemodialysis Patients: Should Liver Biopsy Be Performed Before Renal Transplantation?

Abstract

To evaluate the histologic changes in the livers of renal transplant candidates who were infected with hepatitis viruses, we performed a percutaneous liver biopsy in each of 74 regular hemodialysis patients. Forty percent of them were seropositive for the antibody to hepatitis C virus (anti-HCV) whereas 29.7% had anti-HCV and antibody to hepatitis B surface antigen (antiHBs) concomitantly. Seven (9.5%) were seropositive for only hepatitis B surface antigen HBsAg. Histopathological examination revealed that 30% of patients had chronic active hepatitis (CAH), 11% had chronic persistent hepatitis (CPH), and 3% displayed histopathological evidence of cirrhosis. Eleven of 22 patients with CAH were positive for only anti-HCV, and 2 of 22 were positive for only HBsAg. One patient had HBsAg and anti-HCV together, and 8 of 22 had anti-HBs and anti-HCV concomitantly. None of the anti-HBs positive patients exhibited abnormal histopathological changes. We found no statistically significant difference in histopathological findings between the HBsAg positive and anti-HCV positive patients. As 32 of 74 patients (43%) had some degree of chronic liver disease, we concluded that it is prudent to evaluate liver histology in HBsAg and anti-HCV seropositive renal transplant candidates before transplantation.

Liver biopsy in patients on hemodialysis with hepatitis C virus infection: An important tool

“…In our cohort of 270 cases, only 1 patient showed histological cirrhosis. Except a study by Ozdogan et al .,[ 20 ] almost all other studies showed active hepatitis with varying severity in all the patients biopsied. Some of the studies had tried to correlate various variables with the degree of histological changes, however, data is limited.…”

“…There are limited numbers of studies on liver histology in patients on maintenance HD with HCV infection. After excluding studies that had clubbed dialysis and transplant patients,[ 17 18 19 ] we could find 9 studies between 1997 and 2011, which have reported liver histopathology in patients on maintenance HD[ 19 20 21 22 23 24 25 26 27 ] [ Table 2 ]. Of these 9 studies, 5 are from Turkey.…”

Utilità Della Biopsia Epatica Nella Valutazione d'idoneità al Trapianto di Rene del Paziente con Infezione da Virus C

“…Allo stesso modo, anche nella nostra popolazione si confermano le note correlazioni tra epatite C e fattori di rischio quali, la dialisi extracorporea, le emotrasfusioni e i precedenti trapianti. Il rischio teorico di una più rapida progressione dell'epatite C indotta dall'immunosoppressione, la sostanziale impossibilità a utilizzare l'interferone dopo trapianto per l'elevato rischio di rigetto acuto (5), la correlazione tra severità delle lesioni istologiche pre-trapianto e l'evolutività dell'epatopatia (2) e l'assenza di una precisa correlazione tra dati biochimici e quadri istologici (6), hanno portato a suggerire la biopsia epatica come strumento utile per una corretta valutazione di idoneità al trapianto renale del paziente uremico con infezione da virus C. Tuttavia, non sono ancora disponibili dati definitivi che impongano l'utilizzo di questa procedura in tutti pazienti HCV-positivi (6,7). In questo studio è stato esaminato il quadro morfologico epatico presente in pazienti viremici (HCV-RNA+), che si presentavano al momento della valutazione per l'inserimento in lista trapianto con una normale funzione epatica, con o senza citolisi.…”

Recent Advances on Hepatitis C Virus in Dialysis Population

“…HCV infection remains the most frequently recognized cause of liver damage in chronic kidney disease (CKD) patients [3,4]. Evidence accumulated in the last decade shows a link between HCV and reduced survival in patients on maintenance dialysis; the mechanisms underlying this relationship are an area of active research.…”