title: Histological features of chronic hepatitis C in haemodialysis patients.
abstract: OBJECTIVE
  HCV infection in haemodialysis (HD) patients is still a matter of investigation. The aim of this study was to determine the histology of chronic hepatitis C (CHC) in HCV-infected HD patients within the context of a comparative analysis including non-uraemic patients with CHC. The relative importance of virological, demographic and clinical parameters on disease manifestation was examined.
  
  
  METHODS
  Sixty-one consecutive liver biopsies from HD patients and 326 from non-uraemic patients with chronic HCV infection were comparatively evaluated.
  
  
  RESULTS
  Haemodialysis patients with CHC were older than control subjects (P = 0.031), showing a similar HCV genotype distribution (P = 0.328) and lower viral load (P = 0.001). CHC in HD patients was significantly milder according to stage (P = 0.033), grade and its parameters (periportal activity, portal inflammation and lobular activity) (P < 0.001). The frequency of lymphoid aggregates (10.2% vs. 50%, P < 0.001), bile duct lesions (1.7% vs. 22.1%, P < 0.001) and extent of steatosis (P = 0.022) in HD group was significantly reduced. Multivariate analysis showed that non-uraemic patients had 2.3 times higher risk of developing steatosis independently of genotype distribution and age. In HD group, genotype 3, longer HD duration and age at infection were significantly associated with steatosis, while older age at infection correlated with advanced fibrosis.
  
  
  CONCLUSIONS
  Chronic hepatitis C in HD patients is usually very mild, losing its diagnostic histological features while patient's age and age at infection retain their prognostic significance. The weak inflammatory response, probably because of immunocompromised status and low viral load, may present a beneficial factor in the natural course of the disease.
authors.affiliation: First Department of Pathology, Medical School, University of Athens, Athens, Greece.
authors.forename: Stratigoula
authors.initials: S
authors.lastname: Sakellariou
authors.forename: John N
authors.initials: JN
authors.lastname: Boletis
authors.forename: Vana
authors.initials: V
authors.lastname: Sypsa
authors.forename: Mina
authors.initials: M
authors.lastname: Psichogiou
authors.forename: Dina
authors.initials: D
authors.lastname: Tiniakos
authors.forename: Ioanna
authors.initials: I
authors.lastname: Delladetsima
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D003428:Cross Infection / Q000276:immunology / Q000473:pathology* / Q000821:virology; D005234:Fatty Liver / Q000276:immunology / Q000473:pathology* / Q000821:virology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000276:immunology / Q000473:pathology* / Q000821:virology; D006801:Humans; D008099:Liver / Q000276:immunology / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
keywords: HCV; bile ducts; haemodialysis; histology; lymphoid aggregates; steatosis