Characteristics of hepatitis C in renal transplant candidates.
OBJECTIVE
To characterize hepatitis C in renal transplant candidates and to compare hepatitis C-related liver disease between patients with end-stage renal disease (ESRD) and well-matched control subjects without renal disease.


BACKGROUND
Hepatitis C is common in dialysis patients and can cause morbidity and mortality in renal transplant recipients. Patients with advanced hepatitis C often are excluded from renal transplantation.


METHODS
Forty-six renal transplant candidates and 46 control subjects matched for age, sex, and race without renal disease were included. Demographic, laboratory, and histologic data were compared between patients with ESRD and control subjects.


RESULTS
Alanine aminotransferase levels were significantly lower in patients with ESRD (p < 0.001). Hepatitis C virus RNA levels were similar between groups. Patients with ESRD had less inflammatory activity (p < 0.001) and a lower proportion of bridging fibrosis or cirrhosis (13%) than control subjects (30%, p = 0.043). Clinical and laboratory features did not predict histologic grade or stage of hepatitis C in patients with ESRD. Two complications of percutaneous liver biopsy occurred per three diagnoses of cirrhosis in patients with ESRD. No complications occurred with transjugular liver biopsy in this group.


CONCLUSIONS
Patients with ESRD had less severe hepatitis C than did control subjects. Clinical measurements did not predict histologic findings in renal transplant candidates. Transjugular liver biopsy should be considered to stage hepatitis C in renal transplant candidates due to the risk of percutaneous biopsy in uremic patients.
Cotler
Scott J
SJ
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, U.S.A. scotler@rush.edu
Diaz
Gloria
G
Gundlapalli
Sushama
S
Jakate
Shiram
S
Chawla
Anshuman
A
Mital
Deepak
D
Jensik
Steven
S
Jensen
Donald M
DM
D000328:Adult; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000473:pathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged