Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C.
Iron overload and hepatitis virus C infection cause liver fibrosis in thalassemics. In a monocentric retrospective analysis of liver disease in a cohort of 191 transfusion-dependent thalassemics, in 126 patients who had undergone liver biopsy (mean age 17.2 years; 58 hepatitis virus C-RNA positive and 68 hepatitis virus C-RNA negative) the liver iron concentration (median 2.4 mg/gr dry liver weight) was closely related to serum ferritin levels (R = 0.58; p<0.0001). Male gender (OR 4.12) and serum hepatitis virus C-RNA positivity (OR 11.04) were independent risk factors for advanced liver fibrosis. The majority of hepatitis virus C-RNA negative patients with low iron load did not develop liver fibrosis, while hepatitis virus C-RNA positive patients infected with genotype 1 or 4 and iron overload more frequently developed advanced fibrosis. Hepatitis virus C infection is the main risk factor for liver fibrosis in transfusion-dependent thalassemics. Adequate chelation therapy usually prevents the development of liver fibrosis in thalassemics free of hepatitis virus C-infection and reduces the risk of developing severe fibrosis in thalassemics with chronic hepatitis C.
Dipartimento Biomedico di Medicina Interna e Specialistica, (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy. vito.dimarco@tin.it
Vito
V
Di Marco
Marcello
M
Capra
Francesco
F
Gagliardotto
Zelia
Z
Borsellino
Daniela
D
Cabibi
Francesco
F
Barbaria
Donatella
D
Ferraro
Liana
L
Cuccia
Giovanni Battista
GB
Ruffo
Fabrizio
F
Bronte
Rosa
R
Di Stefano
Piero L
PL
Almasio
Antonio
A
Craxì
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D019190:Iron Overload / Q000150:complications*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology / Q000821:virology; D008297:Male; D012189:Retrospective Studies; D013156:Splenectomy; D013789:Thalassemia / Q000097:blood / Q000209:etiology*; D065227:Transfusion Reaction; D019562:Viral Load