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

Abstract

Hepatitis C virus (HCV) infection is commonest blood borne infection amongst hemodialysis patients. Still, there is paucity of data on liver biopsy in these patients. Our center is doing regular liver biopsy in these patients and thus thought of sharing our experience. In this retrospective study, all patients with HCV infection on hemodialysis were subjected to liver biopsy. Serum bilirubin, liver enzyme, HCV-PCR, genotype and viral load measurement were done in all. Biopsy specimen was stained with H and E, Periodic Acid Schiff, Gomori Stain, Masson Trichrome and Perls Stain. International Working Group scoring system of Ishak et al. was used for Grading and Staging. Of the 270 liver biopsies, mean age of patients was 34.05 ± 10.28 years and 233 (85.3%) were males. Mean duration of hemodialysis was 10.9 ± 7.4 months while of known HCV infection was 5.2 ± 4.0 months. Genotype 3 was commonest followed by 1. All had normal bilirubin and 64 (23.1%) had normal ALT. In 37 (13.3%) patients anti-HCV was not detectable. Mean histology grade was 4.03 ± 1.65 (1-10) and stage was 0.75 ± 0.98 (0-3). Only one patient had cirrhosis on histology. Associated hemosiderosis was seen 10 patients. Only minor complications were observed with no mortality. In conclusion, our study shows that in one-fourth patients with active liver disease, liver enzymes are persistently normal in patients on hemodialysis. Further, carefully performed liver biopsy is reasonably safe procedure though some patients do have non-fatal complications. Liver biopsy helps in assessing disease activity, which otherwise cannot be assessed. Histological grade and stage in these patients is usually mild and cirrhosis is rare. Till such time other non-invasive test is validated, liver biopsy will remain an important test in these patients.

Hemodialysis Patients Treated for Hepatitis C Using a Sofosbuvir-based Regimen

“… 10 Patients with positive anti-HCV antibodies were further investigated for their qualitative HCV RNA, HCV viral load, and HCV genotype as described previously. 10 Because of our previous experience of only 1 patient with histological cirrhosis, 11 we clinically assessed the activity of liver disease, and no patient underwent liver biopsy. Before starting treatment, hemoglobin, total leukocyte count, differential leukocyte count, platelets, reticulocyte counts, and alpha fetoprotein were assessed in all patients using standard methods.…”

Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study

“…Details of liver biopsy in our set-up of patients had been published elsewhere. [ 24 ] None of the patients had raised bilirubin and/or clinical hepatitis at presentation. Other investigations of patients done before start of treatment are shown in Table 2 .…”

“…Previously published studies of Peg-INF monotherapy in these patients are shown in Table 3 for comparative analysis. [ 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 ] The goal of the treatment of HCV-infected patient is to reduce all-cause mortality and liver-related health adverse consequences, including end-stage liver disease and hepatocellular carcinoma, by achieving virological cure as evidenced by an SVR. Although patients treated with either conventional or Peg-IFN-a have similar efficacy and safety results on the basis of meta-analysis studies, one head-to-head randomized trial showed that the overall efficacy and safety in patients treated with Peg-IFN-a were superior to those treated with conventional IFN-α.…”

Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in Karnataka, South India

“…15,16 In a study from north India, genotype 3 was the commonest in CKD patients on hemodialysis. 17 In our study genotype 1 was predominant in CKD patients on hemodialysis, which is in trend with geographical prevalence. In CKD patients genotype 1 was seen in 93.1% and genotype 3 in 6.9% of patients.…”

“…Very few studies have reported genotype in these patients. [15][16][17] In two western studies genotype 1 was commonest. 15,16 In a study from north India, genotype 3 was the commonest in CKD patients on hemodialysis.…”