title: Liver disease in adult transfusion-dependent beta-thalassaemic patients: investigating the role of iron overload and chronic HCV infection.
abstract: BACKGROUND
  Iron overload and hepatitis-C virus (HCV) infection, have been implicated in the evolution of liver disease, in patients with transfusion-dependent beta-thalassaemia major (BTM). However, the impact of these factors in late stages of liver disease in adults with BTM, has not been extensively studied.
  
  
  OBJECTIVE
  To investigate serum indices of iron overload, HCV infection and liver disease, in a cohort of 211 adult Greek patients with BTM, in relation with the findings from liver biopsies.
  
  
  METHODS
  In this cross-sectional study, 211 patients with BTM were enrolled and studied, in relation with HCV infection, ferritin, transaminases, chelation treatment and antiviral treatment. Based on 109 patients biopsied, we correlated liver fibrosis, haemosiderosis and inflammation, with serum indices and HCV status
  
  
  RESULTS
  Among all patients, 74.4% were anti-HCV positive (HCV+). Ferritin was positively correlated with transaminases and negatively correlated with age, while it was not significantly different among HCV+ and HCV- patients. Among the HCV+ patients, 55.4% reported antiviral treatment, while genotype 1 predominated. In a subfraction of 109 patients, in which liver biopsy was performed, 89% were HCV+ and 11% HCV-. Fibrosis was significantly correlated with age (P = 0.046), AST (P = 0.004), ALT (P = 0.044) and inflammation (P < 0.001). Advanced fibrosis was present with even minimal haemosiderosis, independently of ferritin values or HCV history.
  
  
  CONCLUSIONS
  These data suggest that in the late stages of liver disease in BTM patients, iron overload may be the critical determinant, since fibrosis is related to the minimal haemosiderosis, independently of HCV history.
authors: 2nd Department of Internal Medicine, Hippokration General Hospital, Medical School, University of Athens, Athens, Greece. kuduras@hol.gr
authors: Dimitrios
authors: D
authors: Kountouras
authors: Nikolaos J
authors: NJ
authors: Tsagarakis
authors: Evangelia
authors: E
authors: Fatourou
authors: Efthimios
authors: E
authors: Dalagiorgos
authors: Nikolaos
authors: N
authors: Chrysanthos
authors: Helen
authors: H
authors: Berdoussi
authors: Niki
authors: N
authors: Vgontza
authors: Markissia
authors: M
authors: Karagiorga
authors: Athanasios
authors: A
authors: Lagiandreou
authors: Konstantinos
authors: K
authors: Kaligeros
authors: Ersi
authors: E
authors: Voskaridou
authors: Paraskevi
authors: P
authors: Roussou
authors: Evanthia
authors: E
authors: Diamanti-Kandarakis
authors: John
authors: J
authors: Koskinas
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005293:Ferritins / Q000097:blood; D006115:Greece; D006526:Hepatitis C / Q000097:blood / Q000150:complications*; D006801:Humans; D019190:Iron Overload / Q000097:blood / Q000150:complications*; D008107:Liver Diseases / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D000637:Transaminases / Q000097:blood; D017086:beta-Thalassemia / Q000150:complications* / Q000188:drug therapy
chemical_list: D005293:Ferritins; D000637:Transaminases