title: Diagnostic accuracy of the fibrotest in hemodialysis and renal transplant patients with chronic hepatitis C virus.
abstract: BACKGROUND
  An accurate diagnosis of hepatitis C virus (HCV)-related liver lesions is mandatory in dialysis patients and kidney recipients to better define the treatment of and contraindications to kidney transplantation. The aim of this study was to assess the diagnostic accuracy of the fibrotest (a noninvasive method to assess liver fibrosis in HCV on a scale from 0 to 1) in hemodialysis and renal transplant patients infected by chronic HCV.
  
  
  METHODS
  In all, 110 patients with biopsy-proven HCV (60 renal transplant recipients and 50 hemodialysis patients), determined using the METAVIR scoring system, were studied.
  
  
  RESULTS
  Forty-six percent of patients had fibrosis > or =F2. A positive predictive value of a score >0.6 for the presence of significant fibrosis by comparison with liver biopsy was 71%, and an negative predictive value of < 0.2 for excluding significant fibrosis was 77%, respectively. The areas under the ROC curves for the diagnosis of significant fibrosis were 0.66, 0.47, and 0.71 in the global population, hemodialysis patients, and renal transplant patients, respectively. In all, 75% of patients were correctly classified using the fibrotest. If biopsy was restricted to scores in the intermediate range (< 0.6 and >0.2), the index could reduce the indication for biopsy by 47%. The results did not differ significantly in hemodialysis and renal transplant patients.
  
  
  CONCLUSIONS
  The fibrotest has a diagnostic value in hemodialysis and renal transplant patients which is similar to that reported in the general population (75%) and its use could avoid 32% of liver biopsies if it were interpreted in detail in nephrology patients.
authors.affiliation: Liver Diseases Unit, INSERM U-370, Pathological Anatomy Department, Hôpital Necker, 149 rue de Sèvres, 75015 Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Varaut
authors.forename: Helene
authors.initials: H
authors.lastname: Fontaine
authors.forename: Jeanne
authors.initials: J
authors.lastname: Serpaggi
authors.forename: Virginie
authors.initials: V
authors.lastname: Verkarre
authors.forename: Anais
authors.initials: A
authors.lastname: Vallet-Pichard
authors.forename: Bertrand
authors.initials: B
authors.lastname: Nalpas
authors.forename: Francoise
authors.initials: F
authors.lastname: Imbertbismuth
authors.forename: Pascal
authors.initials: P
authors.lastname: Lebray
authors.forename: Stanislas
authors.initials: S
authors.lastname: Pol
mesh_terms: D000328:Adult; D001331:Automation; D015415:Biomarkers / Q000097:blood*; D005260:Female; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry / Q000379:methods; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D018937:Hepatitis C Antibodies