Evaluation of hepatitis B and hepatitis C virus-infected renal allograft recipients with liver biopsy and noninvasive parameters.
BACKGROUND
Patients with end-stage renal disease are at high risk for hepatitis B (HBV) or hepatitis C virus (HCV) infection. Because therapy indication for viral hepatitis depends on virologic, biochemical, and histologic criteria, liver biopsy usually is necessary. Recently, a panel of serum fibrosis markers has been postulated to allow quantification of liver fibrosis by noninvasive means.


METHODS
A cross-sectional study of all hepatitis B surface antigen (HBsAg)- and anti-HCV-positive renal allograft recipients among 900 renal allograft recipients regularly controlled in the authors' outpatient nephrology service was performed. The correlation between histologic, biochemical, and virologic parameters was assessed with an emphasis on the fibrosis marker hyaluronate in this immunosuppressed population.


RESULTS
Twenty-two HBsAg- and 62 anti-HCV-positive patients were analyzed. Based on polymerase chain reaction results, 86% of anti-HCV-positive and 95% of HBsAg-positive patients had actively replicating infection. In 41 of 67 (61%) patients with replicating disease, liver biopsy was performed, and the association of various biochemical parameters with the histologic scores for necroinflammation and fibrosis was investigated. Less than 10% of these patients had advanced fibrosis, although the mean time of infection was more than 15 years. We found no correlation of any of the serum parameters (including hyaluronate) with histologic activity of liver disease except for the peak glutamate-oxalacetate transaminase value recorded during the entire posttransplant period.


CONCLUSIONS
Liver biopsy remains the gold standard for evaluation of liver disease and therapy decision in immunosuppressed renal allograft recipients.
Fehr
Thomas
T
Division of Nephrology, University Hospital, Zurich, Switzerland. thfehr@bluewin.ch
Riehle
Hans-Martin
HM
Nigg
Luzia
L
Grüter
Erwin
E
Ammann
Peter
P
Renner
Eberhard L
EL
Ambühl
Patrice M
PM
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000150:complications / Q000601:surgery; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology*; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000473:pathology; D012086:Reoperation; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D014184:Transplantation, Homologous
D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012709:Serum Albumin; D006820:Hyaluronic Acid; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin