Clinicopathological features of hepatitis C virus infection in dialysis and renal transplantation.
BACKGROUND
Liver biopsy (LB) gives an accurate picture of the severity of hepatitis C virus (HCV) infection in end-stage renal disease. The aim of this study was to find out whether clinical and histopathological course of HCV infection in renal transplant (RT) patients (pts) is different from dialysis (Dx) pts.


METHODS
Forty Dx and 46 RT pts underwent LB. Clinical and biochemical data were retrospectively collected from medical charts. ALT level above the upper limit was described as elevated. LB was done regardless of the ALT level. LB specimens were examined using a semiquantitative scoring system locally modified from Scheuer. Histological activity (grade) and fibrosis (stage) were scored separately.


RESULTS
ALT was elevated in 65% of Dx pts. At the time of LB 30% of Dx pts had elevated ALT and 95% were viremic. Normal/minimal inflammation was detected in 25% of LBs, chronic hepatitis in 72.5%, cirrhosis in 2.5%. Stage and grade were respectively 1.08 +/- 1.02 and 4.30 +/- 2.98. Normal/minimal inflammation was detected in 9% of the 46 RT pts, chronic hepatitis in 84%, cirrhosis in 7%. Stage and grade were respectively 1.74 +/- 1.1 and 5.39 +/- 2.21. Although there was no significant difference in the histological grade between Dx and RT pts, histological stage was significantly higher in RT pts than Dx. The frequency of cirrhosis, hepatitis and normal inflammation was similar in the two groups.


CONCLUSIONS
Histopathological liver injury due to HCV infection seems to be more severe in RT than Dx pts but this does not seem to be clear at the clinical and biochemical level. Sequential histopathological assessment and longer follow-up will be required to clarify this issue.
Department of Nephrology, Ege University Medical School, Izmir, Turkey. dumans@med.ege.edu.tr
Hüseyin
H
Töz
Ercan
E
Ok
Funda
F
Yilmaz
Ulus Salih
US
Akarca
Selda
S
Erensoy
Ayşin
A
Zeytinoğlu
Mehmet
M
Ozkahya
Zeki
Z
Karasu
Gül
G
Yüce
Ali
A
Başçi
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012720:Severity of Illness Index; D013997:Time Factors